Te Wai Pounamu South Island Health Services Planedu.cdhb.health.nz/About-CDHB/corporate... · SOUTH...

Te Wai Pounamu

South Island Health

Services Plan

2016-19

South Island Health Services Plan 2016-19 2

South Island Health Services Plan 2016-19

Produced in May 2016

By the South Island Alliance Programme Office

On behalf of the five South Island District Health Boards

Telephone: 03 378 6631

PO BOX 639, Christchurch

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Forward


FOREWORD

This year the South Island Alliance will continue to dedicate its resources to achieve the South Island Outcomes

Framework and drive improvement and efficiencies across the South Island health sector.

The South Island Alliance Board and Alliance Leadership Team support the South Island Alliance teams and

health services in addressing the challenges we face within the region. We have made significant progress over

the past five years in aligning systems and processes across the region leading to a better experience of care and

outcomes for people. Examples of these include:

Health Connect South (clinical workstation) will roll out in the two remaining DHBs – it will be the first

clinical workstation implemented regionally.

We are implementing single regional services across multiple sites, for example, bariatric surgery.

We continue to work towards meeting challenging targets, including shorter electives wait times and

faster cancer treatment.

Our workforce is becoming more skilled, more focused on patient centred care and more flexible through

the programmes supported by the Workforce Development Hub.

This South Island Health Services Plan (2016-19) maps the direction of the South Island Alliance and draws from

national strategies and priorities, including the draft New Zealand Health Strategy, National Health Targets, the

Minister’s Expectations, and the Operational Policy Framework. The South Island Health Service Plan actions

are interwoven into each of the South Island District Health Board (DHB) Annual Plans with a clear ‘line of sight’

across plans.

The plan provides direction and guidance in terms of how the South Island health system will operate and

prioritise its resources and effort. The plan also continues to challenge how we work together while

acknowledging the progress made and the efforts and energy of all involved.

Through the South Island Alliance, South Island health services have developed a strong platform for

implementing regional and sub-regional priorities; health services can now work together to make the best use

of available resources, strengthen clinical and financial sustainability and increase and improve patient access

to services. We look forward to seeing this plan implemented and building on these actions in the coming years.

Signed by:

Chris Fleming Jenny Black Chair, Alliance Leadership Team Chair, South Island Alliance Board CEO, Nelson Marlborough District Health Board Chair, Nelson Marlborough District Health Board

David Meates Peter Ballantyne CEO, Canterbury and West Coast District Health Boards Chair, West Coast District Health Board

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Forward


Nigel Trainor Murray Cleverly CEO, South Canterbury District Health Board Chair, Canterbury and South Canterbury District

Health Boards

Carole Heatly Kathy Grant CEO, Southern District Health Board Commissioner, Southern District Health Board

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Contents


MINISTER OF HEALTH LETTER OF APPROVAL



CONTENTS

FOREWORD ..................................................................................................................................................... 3

MINISTER OF HEALTH LETTER OF APPROVAL ................................................................................................... 5

CONTENTS ....................................................................................................................................................... 6

INTRODUCTION ............................................................................................................................... 8

1.1 The South Island context ........................................................................................................................... 8

1.2 Our 2016-19 plan ....................................................................................................................................... 8

SETTING OUR STRATEGIC DIRECTION ............................................................................................ 10

2.1 Strategic context ...................................................................................................................................... 10

2.2 National direction .................................................................................................................................... 10

2.3 Regional direction .................................................................................................................................... 11

2.4 Local direction ......................................................................................................................................... 12

2.5 South Island intervention logic diagram .................................................................................................. 13

DRIVERS OF HEALTH SERVICE CHANGE IN THE SOUTH ISLAND ...................................................... 14

3.1 South Island population profile ............................................................................................................... 14

3.2 The South Island Māori Population ......................................................................................................... 16

IMPROVING HEALTH OUTCOMES FOR OUR POPULATION ............................................................. 18

4.1 What are we trying to achieve? ............................................................................................................... 18

4.2 How the Outcomes Framework aligns with service priorities ................................................................. 19

Outcome 1: Improved environments to support health and wellbeing ....................................................... 19

Outcome 2: People have increased access to planned care ......................................................................... 20

Outcome 3: People wait less ........................................................................................................................ 21

Outcome 4: People have prevented and/or delayed burden of long term conditions ................................ 22

Outcome 5: People have fewer and shorter episodes in care facilities ....................................................... 23

Outcome 6: No wasted resource .................................................................................................................. 24

Outcome 7: People are protected from harm or needless death ................................................................ 25

Outcome 8: People die with dignity ............................................................................................................. 26

REGIONAL GOVERNANCE, LEADERSHIP AND DECISION MAKING .................................................. 27

5.1 The role and scope of the South Island region ........................................................................................ 27

5.1.1 Regional governance and leadership .............................................................................................. 27

5.2 Our governance structure........................................................................................................................ 27

5.3 Service Level Alliances (SLA) and workstreams ....................................................................................... 28

5.4 Decision making ....................................................................................................................................... 29

5.4.1 Escalation pathway ......................................................................................................................... 29



5.5 Regional funding and approval model ..................................................................................................... 29

5.6 Managing our risk .................................................................................................................................... 29

5.6.1 Risks and challenges to South Island health services ..................................................................... 30

5.6.2 Regional collaboration mitigating impacts ..................................................................................... 31

Appendix 1 – Regional Collective Decision Making Principles ........................................................................ 32

Appendix 2 – South Island alignment with draft New Zealand Health Strategy ............................................. 33

Appendix 3 – Minister Letter of Expectation 2016 ......................................................................................... 34

Appendix 4 – Service Performance Priorities 2016-2019 ................................................................................ 37

Clinical Services: Sustainability and Clinical Integration ................................................................................. 37

Cancer services ..................................................................................................................................................... 37

Child Health services ............................................................................................................................................. 41

Mental Health and Addiction Services ................................................................................................................. 44

Health of Older People services............................................................................................................................ 47

Palliative Care Services ......................................................................................................................................... 50

Cardiac Services .................................................................................................................................................... 52

Elective Services ................................................................................................................................................... 55

Major Trauma services ......................................................................................................................................... 58

Public Health Services ........................................................................................................................................... 60

Stroke Services ...................................................................................................................................................... 62

Hepatitis C Workstream ....................................................................................................................................... 64

KEY ENABLERS ............................................................................................................................................... 65

Quality and Safety ................................................................................................................................................ 65

South Island Information Services ........................................................................................................................ 68

South Island Workforce Development Hub .......................................................................................................... 74

Support Services ................................................................................................................................................... 79

Appendix 5: Memberships of Alliance groups ................................................................................................ 81

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Introduction


INTRODUCTION

“Steering the course for a sustainable future”

Our vision is a sustainable South Island health system, focused on keeping people well and providing equitable

and timely access to safe, effective, high-quality services as close to people’s homes as possible.

1.1 The South Island context

With a total South Island population of 1,102,630 (23.4 percent of the total New Zealand population)1,

implementing diverse, but similar individual responses duplicates effort and investment and can lead to service

and access inequality. Regional collaboration is an essential part of our future direction.

The South Island Alliance has brought together the region’s five DHBs, along with primary care, aged residential

care, NGOs and consumers, to work collaboratively toward a sustainable South Island health and disability

system that is best for people, best for system.

Our vision to improve the patient journey and the health of the South Island’s population emphasises the

provision of equitable and timely access to safe, effective, high-quality services, as close to people’s homes as

possible. This vision is consistent with the draft New Zealand Health Strategy and the Government’s Better,

Sooner, More Convenient approach to integrated health care.

To ensure our work remains aligned with this direction and to drive our activities, the South Island’s strategic

framework identifies three strategic goals and eight collective outcomes that tell us what success looks like as a

region.

To achieve these goals and outcomes, the South Island Alliance supports existing regional networks to be well-

connected and integrated, align patient pathways, cut waiting times, improve quality and safety, and share

information and resources. We are introducing more flexible workforce models and improved patient

information systems to better connect the services and clinical teams involved in a patient’s care.

By using our combined resources and the strength and experience of our people, our health services can work

towards this shared vision collaboratively. This collaborative approach will enable the region to respond with a

whole of system approach to changes in technology and demographics that will significantly impact the health

sector in coming years.

1.2 Our 2016-19 plan

This updated South Island Health Services Plan (2016-19) provides a framework for future planning and outlines

the region’s priorities for 2016-19. It has been developed by the five South Island DHBs, and the primary care

and community members of the South Island Alliance’s Service Level Alliances and Workstreams. The plan builds

on the achievements and progress of the last five years as it develops a longer term direction for a sustainable

South Island health and disability system that is best for people, best for system.

South Island health services continue to work together at a regional level to make the best use of available

resources, strengthen clinical and financial sustainability and increase access to services. The plan, developed

and supported by clinical leaders, supports the South Island Outcomes Framework (see Section 4 Improving

Health Outcomes), and is governed by our agreed framework for regional decision making (see Section 5

Regional Governance, Leadership and Decision Making).

1 Based on projections used for the 2016/17 Population Based Funding Formula.

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Introduction


South Island DHBs are involved in collaborative activity across a large number of regional and sub-regional

service areas. The areas outlined in the plan are those that have been given national and regional priority. In

addition to these priority areas, regional approaches continue for neurosurgery, primary care emergency

planning and coordination, and audit services. Māori health approaches have been incorporated into the

2016-19 priority area workplans (Appendix 4).

Each priority area—whether supported by regional Service Level Alliance, Workstream or group—is clinically

led, or, as for the Support Services Service Level Alliance, has clinicians involved in the teams and in all key

decision making approaches. Members of the Service Level Alliances and other working groups come from each

of the DHBs and provide breadth of expertise and ownership for development initiatives. The South Island

Alliance Programme Office and a regional communication strategy support the activities across the South Island.

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Setting our strategic direction


SETTING OUR STRATEGIC DIRECTION

2.1 Strategic context

New Zealand’s health system is generally performing well against international benchmarks. However, an aging

population and a growing burden of long-term conditions is driving increased demand for health services, while

financial and workforce constraints limit increasing capacity.

Alongside these health sector drivers, there is growing acknowledgement of the social determinants of health

and, conversely, the role good health plays in social outcomes. Health outcomes for our communities are

interlinked with issues of education, employment, housing and justice, and services will increasingly be asked to

take a broader view of wellbeing.

These pressures mean health services cannot continue to be provided in the same way. While hospitals continue

to be a setting for highly specialised care, we need to move away from the traditional health model.

There are clear opportunities that are supporting evolution in our health sector, for example shifts towards

earlier intervention, investment and preventative care, home and community based care, and new technology

and information systems. Further change towards integrating and better connecting services, not only across

the health sector but inter-sectorally, is needed to achieve better health outcomes with available resources.

2.2 National direction

Acknowledging these challenges and opportunities, New Zealand’s long term vision for health services will be

articulated through the New Zealand Health Strategy. The Strategy intends to support New Zealanders to ‘live

well, stay well, get well’ and sets out five themes to give focus for change in health services:

People powered: understanding people’s needs and partnering with them to design services;

empowering people to be more involved in their health and wellbeing; building health literacy and

supporting people’s navigation of the system

Closer to home: more integrated health services and better connections with wider public services;

investment early in life; care closer to home; focus on wellness and prevention

Value and high performance: focus on outcomes, equity, people’s experience, best-value use of

resources; strong performance measurement; culture of improvement; transparent use of information

to share learning; use of investment approaches to address health and social issues2

One team: operating as a team in a high trust system; flexible use of the health and disability workforce;

leadership and workforce development; strengthening the role of consumers/communities; linking

with researchers

Smart system: information reliable, accurate and available at point of care; data and systems that

improve evidence-based decision making and clinical audit; standardised technology.

More specifically, health services are guided by a range of population or condition specific strategies, including

He Korowai Oranga (Māori Health Strategy), ‘Ala Mo’ui (Pathways to Pacific Health and Wellbeing), Health of

Older People Strategy (currently being updated), Primary Care Health Strategy, Rising to the Challenge (Mental

Health and Addiction Service Development Plan – to be updated in 2016), Palliative Care Strategy, Cancer

Strategy and Diabetes Strategy.

2 In line with the Productivity Commission’s report More Effective Social Services (2015), an investment approach takes into account the long-term impact of an initiative on government spending and quality of life when making funding decisions.



In supporting people to ‘live well, stay well, get well’3, DHBs are expected to commit to Government priorities

to provide better public services; in particular, ‘better, sooner, more convenient health services’. However, the

health sector also contributes to the achievement of other Government priorities, including a number of Better

Public Service results areas, and building a more productive economy.

Alongside these longer-term commitments, the Minister of Health’s annual Letter of Expectation signals annual

priorities for the health sector. In 2016/17 the focus is on:

New Zealand Health Strategy: DHBs need to be focused on the critical areas to drive change that are

identified in the Strategy

Living within our means: DHBs must continue to consider where efficiency gains can be made and look

to improvements through national, regional and sub-regional initiatives

Working across government: cross-agency work to support vulnerable families and improve outcomes

for children and young people is a priority, along with health’s contribution to Better Public Service

Results

National health targets: while health target performance has improved, this needs to remain a focus

for DHBs, particularly the Faster Cancer Treatment target

Tackling obesity: DHBs are expected to deliver on the new health target to address childhood obesity

and show leadership in working to reduce the incidence of obesity

Shifting and integrating services: DHBs need to continue to work with primary care to move services

closer to home and achieve better coordinated health and social services

Health information systems: DHBs need to complete current national and regional IT investments and

DHB, PHO and primary care input is sought in the co-design process of the Health IT Programme 2015-

2020.

2.3 Regional direction

The Nelson Marlborough, Canterbury, West Coast, South Canterbury and Southern DHBs form the South Island

Alliance – together providing services for slightly over 1 million people, or 24 per cent of the New Zealand

population.

In delivering its commitment to better public services and better, sooner, more convenient health services, the

Government also has clear expectations of increased integration and regional collaboration between health

service providers (and other social service agencies).

While each DHB is individually responsible for the provision of services to its own population, the South Island

Alliance recognises that working regionally enables us to better address our shared challenges. The Alliance

improves the systems within which health services are provided by the individual South Island DHBs. Now

entering its fifth year, the Alliance has proven to be a successful model for the South Island, bringing clinicians,

managers, CEOs, primary care, aged residential care and consumers together to work towards a shared vision

of best for people, best for system. The model has become embedded in the culture of the South Island health

system with regional and sub-regional activity ‘business as usual’.

The Alliance Outcomes Framework defines what success looks like for South Island health services, and

outcomes measures will be implemented this year to track if we are heading in the right direction (further detail

in Section 4: Improving outcomes for our population).

3 In the Ministry of Health’s Statement of Intent this is articulated as: New Zealanders live longer, healthier, more independent lives and the health system is cost-effective and supports a productive economy (http://www.health.govt.nz/publication/statement-intent-2015-2019)



The South Island Health Services Plan 2016-19 outlines the agreed regional activity to be implemented through

our seven priority service areas: cancer, child health, health of older people, mental health and addiction,

information services, support services, and quality and safety service level alliances. In addition to this, regional

workstreams will focus on: cardiac services, elective surgery, palliative care, public health, stroke, major trauma

services and hepatitis C. Workforce planning, through the South Island Workforce Development Hub will

contribute to improved delivery in all service areas.

In developing and implementing a collective regional approach we acknowledge the unique pressures and post-

disaster challenges Canterbury face, and the wider impact of this on South Island health services. Five years on

from the earthquakes, prolonged levels of stress, anxiety and poor living arrangements are exacerbating chronic

illness and increasing demand across the Canterbury health system. Patterns following other international

disasters show that psychological recovery after a major disaster can take upwards of a decade, so the increased

demand can be expected to continue for some time. Alongside this increased demand, invasive infrastructure

repairs combined with extensive facilities redevelopment mean capacity is severely stretched across

Canterbury’s specialist services. It will be a number of years before Canterbury is back to full capacity and it is

important that care pathways for the South Island are developed with this in mind.

All South Island DHBs are involved in the service level alliances and workstreams. Each DHB’s commitment in

terms of the regional direction is outlined in their Annual Plans. The South Island Alliance is committed to the

implementation of the New Zealand Health Strategy regionally and is already delivering actions in line with the

Strategy Roadmap and the 2016/17 priorities. This alignment is shown through a South Island version of the

Health Strategy Roadmap of Actions diagram in Appendix 2.

2.4 Local direction

Local health services must cope sustainably with the increasing demand for services and design pathways to

manage the flow of people. Each DHB has local alliances through which they partner with primary care and

other local stakeholders to drive local health service integration. These local alliances support health services

to deliver care in the most appropriate setting and reduce demand by supporting people to remain independent.

While many of the challenges are similar, each DHB must address the particular needs of their community, given

the demographics, infrastructure and geographic features that make up its district. We support working towards

alignment and collaboration where possible, but recognise the need for flexibility to enable local solutions for

local communities.



2.5 South Island intervention logic diagram

The strategic alignment of the South Island Aliance is described in the following intervention logic diagram.

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Drivers of service change


DRIVERS OF HEALTH SERVICE CHANGE IN THE SOUTH ISLAND

3.1 South Island population profile

The Population Based Funding Formula estimates the population of the South Island will be 1,102,630, in

2016/17, an increase of 59,380 people or 5.7 percent from the March 2013 Census. We expect the trends

identified in the 2013 Census to continue in the coming year.





3.2 The South Island Māori Population



SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Improving health outcomes


IMPROVING HEALTH OUTCOMES FOR OUR POPULATION 4.1 What are we trying to achieve?

Our health system is complex and continues to experience multiple challenges. Current challenges include:

increasing patient complexity, increasing technology, a call for increased efficiency, transparency and

accountability from society, changes in social demographics, and workforce shortages. To achieve integrated

and coordinated care we need to support an environment that creates connectivity, alignment and collaboration

within and between all parts of the health system and other related sectors.

The health sector is expected to deliver services that will achieve the vision of the New Zealand Health Strategy:

live well, stay well, get well and to meet Government commitments to deliver ‘better, sooner, more convenient

health services’.

To ensure we are aligned with this direction and to drive our activities, the South Island’s strategic framework

identifies three strategic goals and eight collective outcomes that tell us what success looks like as a region.

The Alliance has developed a set of measures to track performance and demonstrate whether collectively, we

are progressing towards our long term strategic goals and making a positive change in the health of the South

Island populations.

There is no single measure that can demonstrate the impact of health services (or separate the impact of various

health services), so a mix of population health and service access indicators are used to demonstrate

improvements in the health status of the population and the effectiveness of the health system.



Long-term outcome indicators over 5-10 years in the life of the health system will measure change in health

status over time, rather than reach a fixed target. A set of medium-term (3-5 years) indicators will be the primary

means of gauging performance as change will be more evident in these.

These measures will be integrated into our planning and reporting in 2016-17.

4.2 How the Outcomes Framework aligns with service priorities

This section outlines why each of the eight collective outcomes is a priority for South Island health services, what

activities the Alliance is undertaking to support each outcome, and how we intend to track progress. Further

detail of the actions and deliverables can be found in the workplans in Appendix 4. Each of the priority areas

that is supported by a Service Level Alliance or a workstream undertakes an annual work plan, with deliverables

aligned to the South Island Outcomes Framework and national requirements.

Outcome 1: Improved environments to support health and wellbeing

Why is this outcome a priority?

Health promotion and disease prevention contribute to improved health

status and reduction of health inequalities, as well as reducing demand for

healthcare services.

Tobacco smoking, inactivity, poor nutrition and rising obesity rates are major

and common contributors to a number of the most prevalent long-term

conditions. These are avoidable risk factors; preventable through a

supportive environment, improved awareness and personal responsibility, for

health and wellbeing. Supporting people to make healthy choices will enable

our population to attain a higher quality of life and avoid, delay or reduce the

impact of long-term conditions.

What actions are we taking to address this outcome?

Public Health

Health determinants

Develop consistent South Island approaches to address: water fluoridation; air quality and warm homes; and sweetened drinks

Contribute to the Alcohol Harm Reduction Emergency Department Project

Identify coordinated regional opportunities to promote healthy eating and active lifestyles

Environmental Sustainability

Promotion of consistent environmental sustainability monitoring systems

Develop a South Island approach to environmental sustainability



Outcome 2: People have increased access to planned care


Improving access to planned care, rather than emergency care, is important

for patients. By providing planned access to services, people suffering from

health conditions can get better, timelier care; allowing them to regain their

quality of life sooner. This may also allow people to resume or maintain

their productive contribution to the community.

In personalised care planning, clinicians and patients work together using a

collaborative process of shared decision-making to agree goals, identify

support needs, develop and implement action plans, and monitor progress.

This is a continuous process, not a one-off event.


Cardiac Services Electives Services

Improved outcomes for people with suspected acute coronary syndrome

Support access to angiography for high risk populations groups

Improve access to elective services

Improved equity of access to elective services – in particular, bariatric surgery, urology, infertility, plastics services, vascular services, eye services and maxillofacial services

Cancer Services

People get timely access across the whole cancer pathway

Supporting the South Island-wide review of services against national tumour standards, with a focus on supportive care, palliative care and equity

Multi-disciplinary meetings (MDMs) rolled out across the region, supporting quality decision making and a coordinated, planned approach to care

Routes to Diagnosis project to understand how people are accessing cancer services. The initial focus is on those who first present through ED



Outcome 3: People wait less


Delayed access to medical care may subject patients to increased pain,

suffering, and mental anguish. Waiting for healthcare can also have

broader economic consequences, such as increased absenteeism, reduced

productivity, and reduced ability to work. The individual waiting is

affected, as well as family members and friends who are concerned or may

be called to assist them with activities of daily living. Waiting may also

lead to poorer care outcomes and a requirement for more complex

treatments as a result of deterioration in the patients’ condition while

waiting for treatment.

Health services must value people’s time. By looking at the how, where,

when and who of care provision and looking at it from the patient’s

perspective, we can remove barriers and make the system more

integrated. This focus improves quality and efficiencies and supports our

‘best for people, best for system’ approach.


Cardiac Services Cancer Services

Implement an agreed cardiac model of care to ensure all patients get consistent, timely care

People get timely services across the whole cancer pathway

Working with DHBs to understand barriers to achieving the Faster Cancer Treatment health target and overcoming these

Information Services Stroke Services

South Island Patient Information Care System (SI PICS)

Supporting the implementation of SI PICS in Canterbury and Nelson Marlborough DHB sites

Preparing for implementation of SI PICS in other DHBs Emergency Department Information Solution

Provide a regional solution to support visibility of ED activity

eReferrals

Implement a regional eTriage module in Health Connect South that provides the electronic triage functionality

Ensure rapid access to treatment for potential thrombolysis candidates

Each South Island DHB has a system to rapidly confirm a diagnosis of stroke and identify patients who may benefit from thrombolysis therapy

Support all South Island DHBs to implement stroke thrombolysis pathways

Support Services Workforce Development Hub

Facilitate and review regional inter-hospital transfer agreement with St John that improves efficiency and service for patients and hospitals

Implementation of allied health assistants Level 3 training to up-skill and increase flexibility of the workforce

Support flexibility and integration in the workforce by introducing a regional clinical allied health leadership role

Implement a workforce redesign and delegation model (Calderdale Framework) to enable allied health professionals to skill share across professions and safely delegate to kaiawhina (allied health assistants)

Major Trauma Elective Services

A planned and consistent approach to major trauma services

Implement agreed regional and local trauma systems

Supporting DHBs to meet ESPI indicators



Outcome 4: People have prevented and/or delayed burden of long term conditions


Chronic diseases are now the most common cause of death and disability.

People with chronic diseases tend to be high users of healthcare resources

and social care. The prevalence of long-term conditions rises with age and

many older people have more than one chronic condition.

The World Health Organisation (WHO) estimates more than 70 per cent of all

health funding is spent on long-term conditions. As our population ages, the

incidence and burden of long-term conditions increases. Long-term

conditions are also more prevalent amongst Māori and Pacific people and are

closely associated with significant disparities in health outcomes across

population groups.

It is now widely recognised that the care and support needed to live with a

long-term condition requires a radical re-design of services, allowing patients to drive the care planning process. By

intervening early, and with improved coordination and proactive provision of care, people, families and whānau with

complex conditions have improved health outcomes. This supports people to stay well and maintain their functional

independence.


Stroke Services Health of Older People

Rapid access to treatment for potential thrombolysis candidates

Each South Island DHB has a system to rapidly confirm a diagnosis of stroke and identify patients who may benefit from thrombolysis therapy and this system is implemented in each South Island DHB

Implement stroke thrombolysis pathways

Optimise outcomes for all patients with stroke in rural and urban locations

Integrated Stroke Rehabilitation Services

Community stroke rehabilitation is available to aid adjustment and minimise complications

Dementia services

A Cognitive Impairment Pathway (CIP) will be promoted for adoption across all South Island DHBs

Improved services for people with dementia by implementing the New Zealand Framework for Dementia Care in the South Island

Develop appropriate dementia education/training materials for South Island primary healthcare person-centred care

Restorative Consensus Statements

Development of evidence-based statements to help guide service providers and consumers

Child Health Cancer Services

Interventions to reduce hospital admissions

Implement a South Island Health Pathway for dermatitis and eczema

Increase GP training on dermatitis and eczema

A regional integrated healthy weight (obesity) management programme

Develop a regional integrated healthy weight (obesity) management programme

Enhance collaboration with child dental health services

Working with primary care to increase the timely identification of melanoma and reduce unnecessary removal of lesions

Improve the uptake of cervical screening among Maori women



Outcome 5: People have fewer and shorter episodes in care facilities


Reducing the length of stay in healthcare facilities will release capacity in the

system, including beds and staff time, which helps to minimise waiting times,

maximise productivity and improve the patient experience.

Advancements in medical and health technology have enabled the population

to live longer. However, more people are living with co-morbidities and need

complex care interventions. We know that investing in community services

and the community workforce will help to deliver positive health outcomes

and free hospitals to provide more acute and specialised care.

This approach also reduces average hospital length of stay, increases patient

choice and satisfaction, improves health outcomes, reduces unscheduled

healthcare use, embraces prevention and health promotion models, delivers

care closer to people’s homes and saves money.


Cardiac Services Major Trauma

Heart failure

Implement agreed protocols to ensure optimal management of patients with heart failure

Improve the pathway for patients with major trauma

Develop and implement regional destination policies in collaboration with DHBs, ambulance, and air transport providers

Gain understanding of major trauma patient pathways by implementing a national major trauma registry

Health of Older People Child Health

Comprehensive clinical assessment (interRAI)

Comprehensive clinical assessment using a standardised assessment tool (interRAI) facilitating a system-wide approach to common assessment

Monitor population and service data trend to influence changes in service through advocacy

Reduce hospital admissions

Strengthen models of care within primary care – right place, right time, right service

Diabetes

Establish a South Island Diabetes Working Group to improve systems across South Island for young people with Diabetes, in particular Type 1

Mental Health and Addiction Quality and Safety

Access to youth forensic services

Development of community youth forensic services.

Mental health and intellectual disability dual diagnosis

Identify options to support consumers with mental health and intellectual disability dual diagnosis who are inappropriately placed.

Forensic services

Improved adult forensic service capacity and responsiveness.

Access to mental health services

Monitor and support ongoing improvements in the regional provision of eating disorder services, mothers and babies’ services, and alcohol and other drug services

Reduce complications resulting from being in hospital through ongoing quality and safety initiatives, such as improved hand hygiene and prevention of surgical site infections



Outcome 6: No wasted resource


We have an obligation to provide health services in the most efficient way

possible, so patients receive timely access to the most appropriate care, in

the most appropriate place. It’s about getting the greatest value for our

people from the system, enabling evidence to inform how our scarce

healthcare dollars are best invested and ensuring people receive the care

they need as close to home as possible.

As our population ages, so does our workforce. Alongside the other drivers

of change in the health sector, the changing demographics of the workforce

will require us to think differently about the way staff are utilised. We need

to enable health professionals to work at the top of their scope of practice

with the support of an appropriately trained unregulated workforce. We

need to build an innovative and flexible workforce that will support the

emerging models of healthcare.


Workforce Development Hub Workforce Development Hub

Build capacity of the workforce to work flexibly and efficiently

Implement a workforce redesign and delegation model (Calderdale Framework) to enable allied health professionals to skill share across professions and safely delegate to Kaiawhina (allied health assistants)

Facilitate community based attachments for junior doctors (PGY1/2)

DHBs supported to integrate the increased number of PGY1 (NZ citizens and permanent residents) into the workforce

eLearning

Implement a common eLearning platform for the South Island workforce

Nursing Community of Practice has identified and prioritised a regional suite of eLearning packages

Interprofessional

Increase opportunities for inter-professional learning in a clinical environment

Cardiac Services Information Services

ECG storage and sharing

A common regional method of storing and sharing ECGs

HealthOne

Complete the roll-out of HealthOne to SDHB

Complete the roll-out of HealthOne to the Marlborough PHO (NMDHB)

Support Services Cancer Services

Procurement and savings

Aggregate procurement requirements and improve purchasing power

Savings achieved enabling redeployment of funds to appropriate services

Increased rationalisation and standardisation of products and services

Using clinical time effectively to support better patient care through Multidisciplinary Meetings

Working with primary care to promote early diagnosis and care closer to home through the Melanoma project (also reducing unnecessary removal of lesions) and the Route to Diagnosis project



Outcome 7: People are protected from harm or needless death


It is fundamental to health service provision that people receive high quality,

safe care and are protected from harm. This is implicit in the high trust

relationship between patients and health professionals and is regulated

through legislation and professional oversight. As well as the negative

impact on patients, adverse events and delays in treatment drive

unnecessary costs and redirect resources away from other services.

Quality improvement in systems and processes increase patient safety,

reduce the number of events causing injury or harm and improve health

outcomes. Our focus on ‘best for people, best for system’ places an emphasis

on the system of care delivery that prevents errors; learns from the errors

that do occur; and is built on a culture of safety that involves healthcare

professionals, organisations, and patients.


Child Health Health of Older People

Improve Sudden and Unexpected Death in Infants (SUDI) rates

Implement the findings of the audit of the SI sudden death in infancy policy

South Island Children’s Action Plan

Agree South Island regional interventions to better manage safety, reduce family violence and childhood poverty

Programmes to reduce youth risk taking

In partnership with Health Promotion Agency, South Island Public Health Partnership and the Mental Health and Addictions Service Level Alliance, implement the findings of the South Island Emergency Department scoping exercise

Falls prevention and fracture liaison service

Development of an evidence based Fracture Liaison Service

Agree a South Island policy on community based falls prevention programmes based on the evidence of the Otago Exercise Programme

Dementia Services

WiAS programme continues to be expanded in each South Island DHB, reaching a wider range of staff working with people with dementia

Information Services Information Services

eMedicines

SDHB, CDHB, SCDHB ePrescribing and administration project complete

WCDHB, NMDHB ePrescribing and administration implementation commenced

Complete the implementation of eMedicines reconciliation within Canterbury DHB and commence implementation planning for remaining South Island DHBs

Complete the regional implementation by implementing ePharmacy Management within South Canterbury, West Coast, Southern and Nelson Marlborough DHBs

Health Connect South

Complete Southern and Nelson Marlborough DHB’s Health Connect South implementation

Implement a regionally agreed electronic discharge summary

Develop and pilot a mental health solution

South Island Patient Information Care System (SI PICS)

Supporting the implementation of SI PICS in Canterbury and Nelson Marlborough DHB sites

Preparing for implementation of SI PICS in other DHBs



Quality and Safety Workforce Development Hub

Supporting DHBs to make a positive contribution to patient safety and quality of care

Monitor and recommend options for reducing perioperative harm

Supporting consumer involvement in South Island Alliance activity

Incident management and quality improvement

Roll out Safety 1st, the South Island electronic incident management system, to community care providers

Clinical simulation

Clinical simulation is accessible to staff working in the smaller centres and rural areas of the South Island. A coordinated clinical simulation network for the South Island

Lippincott (online evidence based clinical procedures) is introduced to the whole South Island health workforce

Vulnerable workforces

South Island vulnerable workforces are identified and plans established to mitigate these

Increase the participation of Māori and Pacific people in the clinical workforce

Cancer Services Mental Health and Addiction

Support the roll out implementation of Psychosocial and Supportive Care Initiative across the South Island

Implementation of electronic Multidisciplinary Meetings solution will reduce existing variation in processes, minimise clinical risk, and improve care co-ordination and timely documentation

Seclusion and restraint

Collaboration on seclusion and restraint across South Island DHBs with a specific focus on Māori

Outcome 8: People die with dignity


For many people, end of life is a time of increased interaction with health

services and can be a frightening and stressful time for patients and their

whānau. While preventing pain and suffering underlies all healthcare and

treatment, different people will have different views on what this means in

terms of level of medical intervention and what setting they want to be in at

the end of their life. It is important that health services support patients to die

with dignity by enabling them to understand their options and respecting their

needs.


Palliative Care Health of Older People

Equitable access to an integrated palliative care system

All people who are dying and their family/whānau have access to an equitable and quality palliative care service

Primary care provided with expertise and resources to enable patients to die in their preferred place of care

Consumer participation and decision making about palliative and end of life care

Advance Care Planning (ACP)

Develop ACP systems and processes to embed ACP as standard practice for those who will benefit

ACPs are incorporated into the regional information system/plan

South Island DHBs are supported to participate in ‘Conversations that Count’ (CtC) awareness raising day

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Regional governance


REGIONAL GOVERNANCE, LEADERSHIP AND DECISION MAKING

5.1 The role and scope of the South Island region

“Our purpose is to lead and guide our Alliance as it seeks to improve health outcomes for our populations. We

aim to provide increasingly integrated and coordinated health services through clinically-led service

development and its implementation, within a ‘best for people, best for system’ framework.”

5.1.1 Regional governance and leadership

In order to advance the implementation of regional service planning and

delivery, in 2011 the South Island DHBs established an alliance

framework. This approach continues to facilitate the DHBs in working

together to jointly solve problems by sharing knowledge and resources

with a focus on achieving the best outcomes for the region’s population.

The alliance framework has been successful in supporting the DHBs to

achieve in both the enabler and clinical service areas and has been

recognised as a successful model at a national level and by the other

regions.

5.2 Our governance structure

The South Island Alliance focuses South Island DHB collaboration through:

An Alliance Board (the five South Island DHB board Chairs) that

sets the strategic focus, oversees, governs, and monitors overall

performance of the Alliance

An Alliance Leadership Team (the South Island DHB CEOs) that

prioritises activity, allocates resources (including funding and

support) and monitors deliverables

A Regional Capital Committee (SIA Board and Alliance

Leadership Team) that reviews capital investment proposals in

accordance with the agreed regional service strategy and

planning

A Strategic Planning and Integration Team (SPaIT) (Clinical and

management leaders) that supports an integrated approach,

linking the Service Level Alliances (SLA) and workstreams to the

South Island vision, identifying gaps and recognising national,

regional and district priorities

The South Island Planning and Funding Network (SIP&FN)

supports regional alliance issues and collaborates on non-alliance issues, including strategic planning,

meeting of government priorities, statutory requirements, and provides whole of population funding

advice.

South Island Alliance Charter Principles

We will support clinical leadership, and in particular clinically-led service development;

We will conduct ourselves with honesty and integrity, and develop a high degree of trust;

We will promote an environment of high quality, performance and accountability, and low bureaucracy;

We will strive to resolve disagreements cooperatively, and wherever possible achieve consensus decisions;

We will adopt a people-centred, whole-of-system approach and make decisions on a best for system basis;

We will seek to make the best use of finite resources in planning health services to achieve improved health outcomes for our populations;

We will balance a focus on the highest priority needs in our communities, while ensuring appropriate care across all our rural and urban populations;

We will adopt and foster an open and transparent approach to sharing information; and

We will actively monitor and report on our alliance achievements. including public reporting.



5.3 Service Level Alliances (SLA) and workstreams

South Island regional activity involves a wide representation of the key stakeholders including health

professionals, managers, funders, healthcare providers and consumers. The teams are clinically-led with the

exception of the Support Services Service Level Alliance.

A chief executive or senior executive from one of the DHBs sponsors each SLA/workstream to support the team

and where necessary help manage risks. Sponsors also provide a point of escalation for the resolution of issues

if one of the agreed programmes or projects vary from planned time, cost or scope.

Each Service Level Alliance and Workstream also has a member of the Strategic Planning and Integration Team

involved, either as a member or as a link person. This is a new initiative for 2015/16 and the key function for

the increased linkage is to provide feedback and guidance on the strategic direction of the group and to

understand any proposals / recommendations in order to better support the sign-off process at Strategic

Planning and Integration Team and Alliance Leadership Team meetings.

While leadership training and support is provided at a DHB level, the South Island Alliance also supports Chairs

and facilitators through the process and specifically at an annual meeting where the direction of the Alliance is

discussed and a focussed topic is workshopped.

The SLA/workstream is responsible for overseeing the agreed programme of work, and providing overarching

programme and project governance. The work is supported by the staff employed by the South Island Alliance

Programme Office.

South Island Alliance Teams

Multidisciplinary Strategic Team

South Island DHB Chief Executives

South Island DHB Board Chairs

South Island Alliance Board

South Island Alliance

Leadership Team

Strategic Planning and Integration

Team

Service Level Alliances

Workstreams



5.4 Decision making

The South Island Alliance approach to decision making and the process for resolving disputes is detailed in the

South Island collective decision making principles (Appendix 2).

The foundation of the South Island Alliance is a commitment to act in good faith to reach consensus decisions

on the basis of ‘best for people, best for system’.

It is acknowledged that there may be areas within the scope of the activities of the Alliance where a particular

DHB either may wish to, fully or partially, be excluded from the Alliance activities. It is agreed and written into

the Charter that each Board will have this option at the time of commencing, however, once agreed, the Board

will be bound to operate within the scope and decision making criteria agreed. Any DHB intending to exercise

this right will do so in good faith and will consult the other South Island DHBs before exercising this right.

5.4.1 Escalation pathway

The Alliance operates under the following escalation pathway:

Operational group (including SLA/workstreams) to Alliance Leadership Team (South Island DHB CEOs);

Alliance Leadership (South Island DHB CEOs) to Alliance Board (South Island DHB Chairs); and

Alliance Board (South Island DHB Chairs) to Shareholding Ministers.

5.5 Regional funding and approval model

All work undertake by the South Island Alliance must address one or more of the eight outcomes. The region is

acutely aware of the fiscal constraints impacting health services and the need to focus on innovation, service

integration, improved efficiency and reduced waste to support provision of high quality care. Proposals for

regional activity must clearly identify the value proposition for patients and/or the system. The Strategic

Planning and Integration Team review all workplans prior to any funding bids.

As the workplans are developed and endorsed, resource requirements are identified and a budget bid process

is undertaken with the South Island General Managers Planning and Funding. This allows bids to be prioritised

against national, regional and local priorities. Bids are identified that are supported subject to the DHB funding

package and, where requested for significant and /or multi-year investments, a fully costed proposal or business

case. A final recommendation to the South Island Alliance Team is made when the DHB funding package is

known and the GMs Planning & Funding have endorsed the recommendations.

Regional activity that needs project or capital funding for Information Service and other capital investments

involves discussions with South Island General Managers Planning and Funding and South Island Chief Financial

Officers. A recommendation is then made to the South Island Alliance Leadership Team or Regional Capital

Committee (if greater than $500k) for approval.

The South Island Alliance Programme Office manages the operational budget for the Programme Office

activities, including facilitation for the regional planning activities as outlined in the South Island Health Services

Plan. The DHBs fund the Programme Office on a PBFF basis.

5.6 Managing our risk

The South Island DHBs have strengthened their ability to manage risk through their increased regional approach

to health service planning and delivery. Enhanced relationships, greater collaboration and having regional

systems and processes in place all help to better manage the issues and challenges the South Island DHBs

experience locally, and regionally.



5.6.1 Risks and challenges to South Island health services

Christchurch earthquakes

While the repair and redevelopment is gathering momentum, the capacity of the Canterbury health system will

continue to be significantly influenced by the following factors for a number of years:

Prolonged levels of stress, anxiety and poor living arrangements are exacerbating chronic illness and

increasing demand. For example, there has been a sharp increase in demand for mental health services:

over the three years to December 2015, there was a 77 percent increase in rural presentations to

specialist mental health services and a 60 percent increase in child and youth presentations to

community mental health services.

There continues to be uncertainty about the influx of people into Christchurch. Statistics projections

do not appear to fully account for the rebuild population, however spikes in demand are clearly being

felt. Between 2011/12 and 2014/15 the census population aged 25-29 increased by 10 percent, but

emergency department presentations for this age group increased by 38%. Over the same period there

was a 370 percent increase in the number of people from overseas presenting in emergency

departments.

Damage to health infrastructure was extensive, and repair strategies are not simple. Invasive repairs

are having to be carried out by relocating and shifting patients and services in and out to repair rooms

and buildings. This not only disrupts the continuity of care, but complicates the operating environment

and adds additional cost to service delivery. Theatre and bed capacity is reduced and Canterbury DHB

is hiring theatres and outsourcing some surgeries to meet demand and delivery expectations.

Canterbury’s situation is further exacerbated by the unanticipated funding interplay between

fluctuating population projections and the national population based funding formula. The formula was

never designed to deal with the dynamic population shifts and demand being experienced and

calculations of deprivation levels are also considered questionable in an environment of rapid

migration.

South Island demographics and population shifts

It is well acknowledged that the South Island has an older population than the rest of New Zealand, and

consequently an older workforce, which will challenge the way health services are provided in the future.

Alongside these macro level demographic changes, shifts in population location will also impact on health service

provision in the medium to long term. While total population growth is slightly lower in the South Island than

other regions, there is significant internal population movement, resulting in pockets of high population growth

such as in Selwyn, Queenstown-Lakes, Waimakariri, Ashburton and Tasman.

Addressing how and what services to provide in areas that did not previously have a significant population base,

along with the necessary investment in health infrastructure, will be a significant challenge for the South Island

in the medium to long term.

Vulnerable and small services

The South Island has a number of health services that are vulnerable due to difficulty to staff, current service

provision being unsustainable, or low numbers of patients. Developing sustainable models of care needs to

balance demand for services, workforce issues, quality of care, and competing priority for health resources, as

well as community views on access to services and the drive to keep services closer to home.

Financial sustainability

All South Island DHBs are experiencing significant financial constraint as they respond to increasing demands on

health services, and rising workforce and other resource costs, within relatively static funding envelopes.



Hospital redevelopment

In addition to the significant construction work planned or underway across a number of Canterbury hospital

sites and at the Grey Base Hospital in Greymouth, over the next 10 years both Dunedin and Nelson Hospitals will

be redeveloped as they are both nearing the end of their economic life and are no longer fit for purpose.

Although not driven by natural disaster as in Canterbury, the Dunedin and Nelson Hospital redevelopments will

have similar significant financial and capacity consequences for a number of years. Dunedin Hospital, as one of

the South Island’s larger hospitals and reduced capacity may have an impact on the rest of the region.

5.6.2 Regional collaboration mitigating impacts

Our regional approach will help to support the management of the South Island’s risks and challenges. The

Service Level Alliance and workstreams we have in place, particularly around workforce issues and information

services mitigate some of the risks health services are facing. We continue to build on the alignment of support

services, such as human resources and procurement.

To ensure we have a clear understanding of the particular challenges faced by each district, in 2016, the Alliance

Leadership Team will hold one of their monthly meetings in each DHB. This will provide the opportunity to

discuss what is working well for the host DHB, and get an in-depth understanding of issues that need to be

addressed. It is planned that the Strategic Planning and Integration Team and some DHB executive team

members also attend. Travelling to each district is a significant commitment and represents the next step in

ensuring we collectively understand the risks facing South Island health services and work collaboratively to

manage these challenges.

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Appendix One


Appendix 1 – Regional Collective Decision Making Principles

South Island collective decision making principles

Decision Making Principles

The parties will be proactive to ensure that decisions required are made in a timely manner. Where delays in decision

making are unacceptable to any of the DHBs, they can trigger escalation.

Decisions will be taken at the lowest level that meets individual DHBs delegated authority policy requirements, and

escalation will only be used if agreement cannot be reached after reasonable attempts to resolve disagreement.

Where decisions are required of the Chief Executive Group and beyond, documentation will include detailed cost benefit

analysis and an impact analysis which demonstrates both the collective and individual DHB impacts. Evidence that the

South Island CFO’s have supported the cost benefit analysis, and that the relevant Senior Leadership (such as GM’s

Planning and Funding, COO’s, HR, CMO’s, DON’s etc.) have supported the robustness of the impact analysis and

recommendations will be included in the papers.

As much advance notice of decision making requirements will be given as possible. This is particularly pertinent where

the decisions are significant or it is reasonably foreseeable that there will be either divergent views or significant

stakeholder interest. Advance notice will be considered as a part of the relevant groups planning processes.

Where a decision is required to be made, this will be noted through the appropriate agenda, together with supporting

papers, distributed with no less than five working days’ notice, unless shorter notice is supported unanimously by the

parties making the decision.

Decisions will be by consensus.

In the event that a DHB is unable to attend the meeting, either through the substantive member or an alternate, the

relevant DHB will either appoint a proxy or they will subsequently confer with the Chair of the meeting to determine

whether they can support the consensus reached by the attending parties

It is noted that each DHB has slightly different delegations policies, and because of this, time needs to be provided in

any planning process to allow significant decisions to be taken back through individual DHB internal processes. This will

be accommodated in planning processes.

Where consensus agreement cannot be reached, the relevant group will agree to either:

Seek independent input or mediation to attempt to resolve any disagreement, or

Escalate the matter through the escalation pathway noted below.

Key determinants behind whether independent input/mediation/escalation will be used are the relevant group views as to:

likelihood of successful resolution of the disagreement in a timely manner; and/or

whether time constraints permit delay.

Where agreement cannot be reached, the parties will document their perspective of the matter to ensure the party or parties to whom the matter has been escalated are fully informed of the difference of views.

Where independent input or mediation is chosen, the District Health Boards will appoint the independent adviser /

mediator by consensus decision. In the event that consensus is not reached the Director General or nominee will be

the default mediator.

Escalation Pathway

The following is the escalation pathway:

Operational groups to Chief Executive group;

Chief Executive Group to Chair Group; and

Chair Group to Shareholding Minister

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Appendix Two


Appendix 2 – South Island alignment with draft New Zealand Health Strategy

Similar to the Health Strategy’s

Roadmap of Actions, this

diagram indicates how a small

selection of the Alliance’s

activities support the themes

identified in the Health

Strategy

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Appendix Three


Appendix 3 – Minister Letter of Expectation 2016





SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Appendix Four


Appendix 4 – Service Performance Priorities 2016-2019

The South Island Alliance ‘Best for People, Best for System’ Framework underpins the agreed actions to achieve:

improved health and equity for all populations, improved quality, safety and experience of care and best value

for public health system resources.

Clinical Services: Sustainability and Clinical Integration

Cancer services

Reducing the burden of cancer

Lead CEO: David Meates (Canterbury DHB)

Chair: Dr Steve Gibbons, Consultant Haematologist (Canterbury DHB)

Clinical Lead: Shaun Costello, Clinical Director SCN, Radiation Oncologist (Southern DHB)

The Southern Cancer Network (SCN) has been formed to:

Provide a framework that supports the linkages between the South Island DHBs, DHB specialist service

providers, Non-Government Organisations (NGOs), Public Health Organisations (PHOs), and consumers.

Coordinate implementation of the New Zealand Cancer Plan across the South Island.

Provide a formal structure that supports improvement in coordination of population programmes for

prevention and screening and the quality of treatment.

Five key focus areas set the direction of this work plan:

South Island Faster Cancer Treatment

South Island Cancer Service Coordination and Quality Improvement: Ensure people have access to

services that maintain good health and independence and receive excellent services wherever they are.

Services make the best use of available resources

South Island Cancer Service reducing inequalities

South Island Clinical Cancer Information System: Implementation of the South Island Clinical Cancer

Information System (SICCIS): Robust cancer data and information sources are developed and shared

that enable informed service development & planning decision-making

Southern Cancer Network Support For National Projects: Ensure the tumour standards continue to

promote quality of care and guide uniform standards of service provision across DHBs.

Note – all workplans are tentative pending budgeting and resourcing decisions.



MILESTONES DASHBOARD 2016-19

ITEM

NO

DELIVERABLE

2016-2017

APPROVED

SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE

2018-2019 RESPONSIBILITIES

CLINICAL SERVICES: SUSTAINABILITY & CLINICAL INTEGRATION

Southern Cancer Network SOUTH ISLAND FASTER CANCER TREATMENT

People get timely services across the whole cancer pathway (screening, detection, diagnosis, treatment and management, palliative care)

Achieving the Faster Cancer Treatment Health Target & improved or maintained performance against the Policy Priority (PP30) Faster Cancer Treatment Indicators

1 Support DHBs to deliver the extended FCT target of ‘At least 90% of patients receive their first treatment within 62 days of being referred with a high suspicion of cancer and a need to be seen within 2 weeks by July 2016’

Q1, Q2, Q3, Q4

ongoing ongoing Contributors: SCN coordinate and support the process in collaboration with the DHBs

Reported in: SIHSP

2 Continue to support the maintenance or improvement of the 31 day indicator: proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment within 31 days (85% target for PP30 31 day indicator)

Q1, Q2, Q3, Q4


Reported in: SIHSP

3 Support DHBs with undertaking and delivering the FCT Round 2 Funded Projects

Q1, Q2, Q3, Q4


Reported in: SIHSP

4 Undertake a focused review to understand the ‘Route to Service Access/Diagnosis’ for all SI cancer patients, with a focus on first presentation through ED

Q2, Q4 ongoing SCN supported by DHBs

Maintaining the National radiotherapy and chemotherapy waiting time targets

5 Maintain oversight of delivery of the National radiotherapy and chemotherapy waiting time targets: all patients, ready for treatment, wait less than 4 weeks for radiotherapy and chemotherapy

Q1, Q2, Q3, Q4

ongoing ongoing SCN supported by DHBs

SOUTH ISLAND CANCER SERVICE COORDINATION AND QUALITY IMPROVEMENT People have access to services that maintain good health and independence and receive excellent services wherever they are. Services make the best use of

available resources

The national tumour standards of service provision are implemented

6 Support the South Island-wide reviews of services against national tumour standard for 2 further tumour areas

Q2, Q4 ongoing ongoing Contributors: SCN coordinate and support the process in collaboration with the DHBs

Reported in: SIHSP

7 Disseminate findings of audits undertaken in 2015-16

Q2, Q4 2 further tumour site audits will be undertaken

2 further tumour site audits will be undertaken

Contributors: SCN coordinate and support the process in collaboration with the DHBs

Reported in: SIHSP




ITEM

NO

DELIVERABLE

2016-2017

APPROVED

SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE


8 Supporting DHBs and Alliance teams work collaboratively in preparation for the introduction of a national bowel screening programme (tbc)

Q4 ongoing ongoing Contributors: SCN coordinate and support the process in collaboration with the DHBs

Reported in: SIHSP

9 Support DHBs to implement national prostate referral guidelines through the sharing of available information and data and working regional to address issues as they arise

Q4 Contributors: SCN as required

Reported in: SIHSP as required

Improved functionality and coverage of MDMs across the region

10 Implement and rollout the regionally agreed MDT recommendations and service improvement initiatives started in 2015-16 (subject to funding)

Q1, Q2, Q3, Q4

ongoing ongoing Contributors: SCN & SI DHBs

Reported in: SIHSP

11 Promote and implement the integration of FCT within the functionality and remit of MDTs

Q1, Q2, Q3, Q4


Reported in: SIHSP

Initiatives to understand and harmonise medical and radiation oncology services

12 Review and evaluate the heterogeneity of practice within radiation oncology, and optimal use of radiotherapy across the South Island (subject to available resources)

Q4 For 2017-18 focus may be medical oncology

Too early to indicate at this time

Contributors: SCN & SI DHBs

Reported in: SIHSP

Progress and enhance the SCN organisational infrastructure within the South Island Alliance

13 Undertake an annual assessment of the Cancer Clinical Priorities, through the South Island/SCN Cancer Clinical Leads Group

Q2, Q4 Too early to indicate at this time Too early to indicate at this time

Contributors: SCN & SI DHBs

Reported in: SIHSP

SOUTH ISLAND CANCER SERVICE REDUCING INEQUITIES People have access to services that maintain good health and independence and receive excellent services wherever they are. Services make the best use of

available resources

Initiatives that reduce inequalities and support access to cancer services

14 Improved understanding and collection of ethnicity data cross the whole health spectrum

Q2, Q4 ongoing ongoing Contributors: SCN & SI DHBs

Reported in: SIHSP

15 Support the rollout of the Maori Cancer Pathways Project across the South Island

Q1, Q2, Q3, Q4


Reported in: SIHSP

16 Review and develop a plan to increase the uptake of cervical screening among young Maori (Te Waipounamu Maori Leadership Group (TWMLG) Priority area)

Q1, Q2, Q3, Q4


Reported in: SIHSP, Maori Health Plans

17 Support a Maori Awareness Hui in the SI with the TWMLG (to be confirmed)

Q4 Will depend on priorities for Maori Cancer Health

Will depend on priorities for Maori Cancer Health

SCN

18 Support the rollout and implementation of the Psychosocial and Supportive Care Initiative across the South Island, and assess early findings

Q1, Q2, Q3, Q4


Reported in: SIHSP




ITEM

NO

DELIVERABLE

2016-2017

APPROVED

SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE


SOUTH ISLAND CLINICAL CANCER INFORMATION SYSTEM Support the implementation of the NZ Cancer Health Information strategy, Ready access to timely, accurate and appropriate cancer data and information across

the SI for all Stakeholders,

Implementation of the South Island Clinical Cancer Information Service (SICCIS): Robust cancer data and information sources are developed and shared that enable informed service development & planning decision-making

19 Develop a plan to support and implement the NZ Cancer health Information Strategy across the SI

Q1, Q2, Q3, Q4


Reported in: SIHSP

20 Produce and further develop a Quarterly Cancer Dashboard to understand progress against cancer standards and targets, and to identify areas for service improvement

Q1, Q2, Q3, Q4


Reported in: SIHSP



Child Health services

Working together to improve the health outcomes for children and their families living in the South Island

Lead CEO: Chris Fleming (Nelson Marlborough DHB)

Clinical Lead: David Barker, Paediatrician (Southern DHB)

The Child Health SLA (CHSLA) has been formed to improve the health outcomes for children and young people

of the South Island through:

Transforming healthcare services, supporting clinical decision making and the shifting of activities closer

to home and communities that children and young people live in.

Working in partnership and linking with national, regional and local teams/groups to make (and assist

the South Island DHBs to make) strategic health care decisions using a ‘whole-of-system’ approach.

Supporting collaboration and integration across the South Island DHBs (primary, secondary and tertiary

interfaces) and inter-sectorial groups/organisations (education, social welfare) to make the best of

health resources.

Balancing a focus on the highest priority needs areas in our communities, while ensuring appropriate

care across all our populations.

Establishing working groups to advise on and guide the development, delivery and monitoring of new

initiatives across South Island children and young people’s health services.

Six key focus areas set the direction of this work plan:

Growing up Healthy - responding to national strategies for improving children's health outcomes and

preventing child abuse.

Young Persons Health - responding to the Prime Ministers youth Mental Health project

Access to Child Health Services - supporting innovation, good practice and equity

Successful Transition into Healthy Adulthood for Children with Lifelong Health Conditions

To adequately address the Challenges of Behavioural Problems in Children and Young People

Consumer Consultation


ITEM NO

DELIVERABLE 2016-2017

APPROVED SCHEDULE



RESPONSIBILITIES


CHILD HEALTH SERVICES ACCESS TO CHILD HEALTH SERVICES

A regional integrated obesity management programme

1a

Develop regional integrated Healthy Weight management programme

Q4 Ongoing monitoring and evaluation of programme

Ongoing monitoring and evaluation of programme

Contributors: SI Child Health SLA, SI PHP

Reported in: SIHSP

(CDHB lead - dependent on funding)

1b Work with DHBs to align Childhood Healthy Weight Program with the Ministry of Health child obesity health target

1c Enhance collaboration with child dental health services

1d Maintain awareness of the healthy family initiatives in Heathcote Spreydon and Invercargill




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

2

Agree approach and implement Electronic Growth chart to record growth from birth

Q4 Contributors: SI Child Health SLA,

SI IS SLA

Reported in: SIHSP

YOUNG PERSONS HEALTH - responding to the Prime Ministers Youth Mental Health project

Support programmes which reduce youth risk taking resulting in injury/disease from smoking, alcohol, drug and sexual diseases

3a In partnership with Health Promotion Agency, SI Public Health Partnership and SI Mental Health and Addictions SLA, implement recommendations of SI ED scoping exercise (subject to funding)

Q3 Implementation of agreed findings

Continuous evaluation of mechanisms in place

Implementation of agreed findings

Continuous evaluation of mechanisms in place

Contributors: SI Child Health SLA, MHSLA, SI PHP, HPA

Reported in: SIHSP

3b Support DHBs to implement the Ministry of Health’s Sexual and Reproductive Health Action Plan 2016 - 2016 (once finalised) as it relates to teen pregnancy.

Q4 Implementation of agreed outcomes

Implementation of agreed outcomes

Contributors: SI Child Health SLA

Reported in: SIHSP

GROWING UP HEALTHY - responding to national strategies for improving children's health outcomes and preventing child abuse

South Island Children’s Action Plan (Government strategy)

4a Support the SI DHBs to understand and respond to information reported from e-Prosafe

Q4 SI Child Health SLA

4b Identify and monitor the implementation of agreed South Island regional interventions to better manage safety, reduce family violence and reduce childhood poverty.

Q4 Continuous evaluation of outcomes

Continuous evaluation of outcomes

Contributor: SI Child Health SLA, SI PHP

Reported in: SIHSP

Regional Sudden and Unexpected Death in Infants (SUDI) rates continue to trend downwards

5 Implement the findings of the audit of the SI sudden death in infancy policy

Q4 Ongoing monitoring and evaluation of audit outcomes

Ongoing monitoring and evaluation of audit outcomes


Reported in: SIHSP

ACCESS TO CHILD HEALTH SERVICES

supporting innovation, good practice and equity based on the Children's Commissioner Compass report 2013

Interventions to reduce hospital admission for skin infections and respiratory conditions with emphasis on at risk children and families, Māori and Pacific

6 Support the SI Diabetes Working Group to implement the areas of work identified in their workplan, including understanding of the current delivery of services and resources to Type 1 Diabetic consumers

Q4 Implement findings of Working Group

Review further and implement findings of Working Group

Contributors: SI Child Health SLA, Child Health SLA Diabetes Working Group

Reported in: SIHSP

7 Interventions to embed a downward trend in avoidable hospital admissions for children with Dermatitis and Eczema

Q3 Ongoing monitoring of hospital admission rates and ED presentations

Ongoing monitoring of hospital admission rates and ED presentations


Reported in: SIHSP

8 Understand the triage process of paediatric non-acute referrals from primary to secondary care in each SI DHB to provide better integrated care so that children can receive the most appropriate services, in the right setting in a timely way to improve overall health outcomes

Q4 Continuous evaluation of triage process

Continuous evaluation of triage process


Reported in: SIHSP

ADDRESS THE CHALLENGES OF BEHAVIOURAL PROBLEMS IN CHILDREN AND YOUNG PEOPLE

Strengthen models of care within primary care Right place Right time Right Service

9 Develop a South Island under 5 behavioural pathway (to be confirmed)

Q4 To be decided To be decided Contributors: SI Child Health SLA

Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

CONSUMER CONSULTATION

To include children, young people and whanau in the planning , delivery and evaluation of health services

10 Develop a child/youth/parent/caregiver survey that can be used across the South Island

Q4 Ongoing consultation with consumers and input into workplan

Ongoing consultation with consumers and input into workplan


Reported in: SIHSP

SUCCESSFUL TRANSITION INTO HEALTHY ADULTHOOD FOR CHILDREN WITH LIFELONG HEALTH CONDITIONS

To provide youth specific services and transition planning/clinics to young people with a range of diseases

11 Agreed transition pathway implemented for young people with complex disability and with lifelong health conditions

Q4 Ongoing monitoring and evaluation of Healthpathway

Ongoing monitoring and evaluation of Healthpathway


Reported in: SIHSP



Mental Health and Addiction Services

Where people in Te Waipounamu/South Island need assessment, treatment and support to improve their

mental health and well-being, they will be able to access the interventions they need from a range of

effective and well integrated services. The Mental Health and Addictions Service Level Alliance will provide

advice, guidance and direction to the mental health sector to strengthen integration, while improving value

for money and delivering improved outcomes for people using services.

Lead CEO: Nigel Trainor (South Canterbury DHB)

Clinical Lead: Dr David Bathgate, Consultant Psychiatrist ( Southern DHB)

The Mental Health and Addiction SLA (MHSLA) has been formed to provide advice, guidance and direction to

the South Island mental health sector through:

Best integration of funding and population requirements for the South Island.

Providing an integrated service across the continuum of primary, community, secondary and tertiary

services.

Ten key focus areas set the direction of this work plan:

Alcohol and Other Drug Services

Workforce

People with low prevalence disorders

Mental Health and Addiction Service Capacity for People with High and Complex Needs

Youth Forensic Service Capacity and Responsiveness

NGO provision

Māori Mental Health

Access to the range of Eating Disorder Services

Adult Forensic Services

Perinatal and Maternal Mental Health Service options as part of a Service Continuum


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES


Mental Health and Addiction Service Level Alliance ALCOHOL AND OTHER DRUG SERVICES

Withdrawal management and the implications of the new AOD legislation

1 Advice provided to the implementation of a South Island withdrawal management plan pending the implications of the new legislation

Q4 Consider findings of 2016/17 work

MHASLA

Reported in: SIHSP

WORKFORCE

Workforce development recommendations and integrated plan for primary and NGO sector

2 Developing a workforce that supports the South Island withdrawal management plan pending the implications of the new legislation


Lead: MHSLA

Reported in: SIHSP

3 Develop the capacity and capability of the practice nurse workforce


Lead: MHSLA

Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

4 Develop a regional approach to increasing NESP capability in the NGO/Community setting


Lead: MHSLA

Reported in: SIHSP

PEOPLE WITH LOW PREVALENCE DISORDERS.

Physical health outcomes of people with low prevalence disorders.

5 Develop a plan to support the physical health of people with low prevalence disorders. The initial focus to be on regional services.

MHASLA to agree an approach and seek agreement from the sector

Q4 Broaden the focus of the work MHSLA

Reported in: SIHSP

MENTAL HEALTH AND ADDICTION SERVICE CAPACITY AND CAPABILITY FOR PEOPLE WITH HIGH AND COMPLEX NEEDS

Forensic Services

6 A gap analysis of the barriers to transition between inpatient forensic services to community based services


MHASLA

Reported in: SIHSP

YOUTH FORENSIC SERVICE

Youth forensic service capacity and responsiveness

7 Report on trends in the new youth forensic services

Q1,2,3,4 Consider findings of 2016/17 work

Implement alternatives as appropriate.

Lead: CDHB and SDHB Youth Forensic leads

Reported in: SIHSP

8 Agreed regional pathway for youth forensic services


Implement alternatives as appropriate.

Lead: Regional Youth Forensic Service Leads

Reported in: SIHSP

NGO PROVISION

Regional Residential AOD Services

9 Develop and review reports from the NGOs that provide regional services including access, trends, key performance indicators and quality improvement activities

Q1,2,3,4 Build on data gathered / experience of previous year

Build on data gathered / experience of previous year

NGOs that provide regional services

Reported in: SIHSP

MAORI MENTAL HEALTH

Priority focus on Maori mental health

10 Partner with services to inform the physical redevelopment of regional services


Lead: Regional Service

Te Herenga Hauora

Reported in: SIHSP

EATING DISORDERS

Continued regional provision of eating disorder inpatient services

11 Develop and review reports from the regional service including access, trends, key performance indicators and quality improvement activities.



Lead: CDHB Eating Disorders service

Reported in: SIHSP

ADULT FORENSIC SERVICES

Improved adult forensic service capacity and responsiveness

12 Prison screening data provided (Prison screening occurs within agreed timeframes with 80% of prisoners referred seen within 7 days of receipt of referral)

Reports

November 2016,

February 2017, May

2017

Deliverable to be agreed with the national network

Lead: CDHB and SDHB Adult Forensic Service

Reported in: SIHSP

13 Report on waiting lists and times for people in prisons requiring assessment in forensic services

Q4 Continue to work with national partners

Lead: CDHB and SDHB Adult Forensic Service

Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

PERINATAL AND MATERNAL MENTAL HEALTH SERVICE OPTIONS AS PART OF A SERVICE CONTINUUM

Continued regional provision of regional mothers and babies services

14 Develop and review reports from the regional service including access, trends, key performance indicators and quality improvement activities



Lead: CDHB Mothers and Babies service

Reported in: SIHSP

ALCOHOL AND OTHER DRUG SERVICES

Continued regional provision of alcohol and other drug services

15 Develop and review reports from the regional service including access, trends, key performance indicators and quality improvement activities



Lead: Regional alcohol and other drug service

Reported in: SIHSP



Health of Older People services

Best healthcare for older people everywhere in the South Island

Lead CEO: Chris Fleming (Nelson Marlborough DHB)

Clinical Lead: Dr Val Fletcher (Canterbury DHB)

The Health of Older People SLA (HOPSLA) has been formed to lead the development of health and support

services for older people across the South Island through:

Developing sustainable models of care and systems for the delivery of quality health services for older

people.

Providing expertise and guidance around delivery of service to the South Island population over 65 (to

those close in age and need).


Dementia Services

Restorative Model of Care

Comprehensive Clinical Assessment (InterRAI)

Falls Prevention & Fracture Liaison Service

Advance Care Planning


ITEM NO

DELIVERABLE

2016-2017

APPROVED SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE



Health of Older People Service Level Alliance

ADVANCE CARE PLANNING

1 Support DHBs to develop ACP system implementation with processes to embed ACP as standard practice for those who will benefit

Q2,4 South Island DHBs are supported to develop ACP systems and processes to embed ACP as standard practice for those who will benefit

South Island DHBs are supported to develop ACP systems and processes to embed ACP as standard practice for those who will benefit

HOPSLA

SI ACP Steering Group

2 ACP L 2 Training is available in a planned manner for staff in each DHB district in South Island (subject to resources)

Q1,3 ACP L 2 Training is available in a planned manner for staff in each DHB district in South Island

ACP L 2 Training is available in a planned manner for staff in each DHB district in South Island

3 Support South Island DHBs to adopt the national consistent ACP documents across the health continuum

Q4 Each SI DHBs develop and implement a system to moderate an individual’s written ACP before plan published electronically.

Regionally consistent SI ACP Policies are embedded within each DHB

An individual’s written ACP form is available electronically at the point of acute care including ambulance

HOPSLA


SI DHBs




ITEM NO

DELIVERABLE

2016-2017

APPROVED SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE


4 Support SI DHBs to participate and support National Conversations that Count Day. This will encourage individuals, communities and health staff to have conversations useful for a person to document their ACP and develop a shared understanding of an individual’s choice

Q2,3 Encourage and Support individuals, communities and health staff to have conversations useful for a person to document their ACP and develop a shared understanding of an individual’s choice

CtC education (Peer education for the public delivered ‘by the public’) is available in each SI DHB

Encourage and Support individuals, communities and health staff to have conversations useful for a person to document their ACP and develop a shared understanding of an individual’s choice

CtC education (Peer education for the public delivered ‘by the public’) is available in each SI DHB

HOPSLA


DEMENTIA SERVICES

5

Embed the adoption of the dementia care pathways in the South Island to support people with dementia, their family and whānau to maximise their independence and well-being by reducing stigma and providing information, education and an integrated, holistic approach to dementia care.

A high level measure of progress in achieving items 6 & 7 will be the number of views of the Cognitive Impairment Pathway.

Q1, Q4

South Island Regional and District plans embed a Person Centred Care approach to services that enables people with dementia, their family and whānau to be valued partners in an integrated health and support system.

Regional participation occurs regularly.

South Island Regional and District plan’s embed a Person Centred Care approach to services that enables people with dementia, their family and whānau to be valued partners in an integrated health and support system.

Regional participation occurs regularly.

HOPSLA

DHB Dementia teams

6 Embed a culture of ‘Living Well’ with Dementia in South Island communities through use of educational programmes and support groups to support informal careers in the South Island.

This will involve collecting information about the range and spread of education programmes for informal carers; reporting on gaps and opportunities; reporting on primary care dementia education uptake; and reporting on ‘Walking in another’s shoes’ uptake.

Q2,4 Embed delivery of dementia awareness and responsiveness education programmes in a consistent manner in the SI. This will improve awareness and responsiveness and provide on-going support and overview to strengthen components of dementia care pathways for people with dementia and their families/whanau

Embed delivery of dementia awareness and responsiveness education programmes in a consistent manner in the SI. This will improve awareness and responsiveness and provide on-going support and overview to strengthen components of dementia care pathways for people with dementia and their families/whanau

HOPSLA

7 Continue to develop Walking in Another’s Shoes programme material for other staff groups (subject to funding)

Commence the development of material for use with a 2 day workshop for Aged Residential Care Managers

Q1,3,4 Walking in Another’s Shoes programme continues to be expanded in each South Island DHB programme reaching a wider range of staff working with people with dementia

Walking in Another’s Shoes programme continues to be expanded in each South Island DHB programme reaching a wider range of staff working with people with dementia

HOPSLA

Walking in Another’s Shoes Development Team

RESTORATIVE MODEL OF CARE

8 Promote the uptake and use of South Island approved principles for restorative care by all services in the South Island

Q3,4 Older people will be supported to set and achieve goals by a co-ordinated and responsive health and disability support service that also enables them to maintain their social connections with community life.

Review the webpage

Older people will be supported to set and achieve goals by a co-ordinated and responsive health and disability support service that also enables them to maintain their social connections with community life.

Review the webpage

HOPSLA




ITEM NO

DELIVERABLE

2016-2017

APPROVED SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE


COMPREHENSIVE CLINICAL ASSESSMENT (interRAI)

9 Promote SI health professions to use the information from comprehensive clinical assessment (interRAI) proactively in plan of care and in service planning/ development.

Analyse specific areas of the data from all SI DHBs

Q2,3,4 Embed the necessary elements of comprehensive clinical assessment (interRAI) processes for older people in the South Island DHBs

Embed the necessary elements of comprehensive clinical assessment (interRAI) processes for older people in the South Island DHBs

HOPSLA

SI System Clinicians

10 Monitor interRAI reports to identify trends.

Q1,2,3,4 Monitor population and service trends data to influence changes in service through advocacy

Monitor population and service trends data to influence changes in service through advocacy

HOPSLA

SI System Clinicians

FALLS PREVENTION AND FRACTURE LIAISION SERVICE

11 Facilitate SI DHBs to share information and ideas to progress falls prevention programmes in a consistent manner

Encourage development of Fracture Liaison Services in each SI DHB

Q2,4 Implement well tested programmes for fall and fracture prevention in SI DHBs.

Opportunities for further development of Falls prevention/FLS are identified

Implement well tested programmes for fall and fracture prevention in SI DHBs.

Opportunities for further development of Falls prevention/FLS are identified

HOPSLA+Q&S SLA

Falls Prevention teams

FLS teams



Palliative Care Services

High quality, person centred, palliative and end of life care available to the population of the South Island,

according to need and irrespective of location.

Clinical Lead: Kate Grundy, Consultant Physician in Palliative Medicine (Canterbury DHB)

The Palliative Care Workstream has been formed to promote the development of and equitable access to a high

quality palliative care integrated system for all people across the South Island through:

The development of an integrated palliative care system, and multidisciplinary workforce across the

South Island.

An integrated system approach to local and South Island Palliative care linkages across the spectrum of

services and providers to benefit the patient journey.

Four key focus areas set the direction of this work plan:

Information Technology and Services

Hospice and Hospital Palliative Care Services

Primary and Community Care

Networking and Engagement

Palliative Care is a workstream within the Health of Older People Service Level Alliance


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

CLINICAL SERVICES: SUSTAINABILITY AND INTEGRATION

Palliative Care

INFORMATION TECHNOLOGY AND SERVICES

By using new electronic systems and tools health professionals are able to securely share and gather relevant patient information that will result in safer, better and timely palliative care to patients

1a

To inform and influence the development of information systems within the South Island that will deliver a more efficient and safer transfer of patient information between Palliative Care Providers (including Hospice services) across the SI while reducing costs and risk

Q4 Ongoing implementation of Information Technology developments

Ongoing implementation of Information Technology developments

Contributors: SI PC WS SI IS SLA Reported in: SIHSP

1b Following the completion and evaluation of the current pilot, support the development and the roll out of Palliative Care interRAI across the South Island

Q4 Roll out as agreed Roll out as agreed Contributors: SI PC WS SI IS SLA Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

HOSPICE AND HOSPITAL PALLIATIVE CARE SERVICES

To provide all people who are dying and their family /whanau access to an equitable and quality palliative care service wherever that service may be located in the South Island

2a Use the information from Hospital and Hospice Surveys and the evaluation of palliative care in primary care (PHOs ARC and P&F) to promote regional consistency and access to resources. Inform and influence SI DHBs so services are aligned to the Resource and Capability Framework for Adult Palliative Care and the work of the National Adult Palliative Care Review

Q4 Develop and monitor initiatives identified as a result of Palliative Care bench marking

Develop and monitor initiatives identified as a result of Palliative Care bench marking

Contributors: SI PCW Reported: SIHSP

2b Working within the National Paediatric Palliative care Guidelines: provide high level guidance within the SI to those providing Paediatric palliative care

Q4 Monitor and progress any initiatives or issues as appropriate to Paediatric Palliative Care

Monitor and progress any initiatives or issues as appropriate to Paediatric Palliative Care

Contributors: SI PCW Reported: SIHSP

PRIMARY AND COMMUNITY CARE

To provide the expertise and resources to enable patients to die in their preferred place of care.

3a Conduct the survey and analyse the findings of the Primary Palliative Care Project using information provided by SI ARC, Planning and Funding and Primary Care (subject to funding availability)

Q4 Work with stakeholders to deliver on key priorities to influence change

Work with stakeholders to deliver on key priorities to influence change

Contributors: SI PCW Reported in: SIHSP

3b Explore and understand how Palliative Care is provided by St John

Q4 Continue to access and apply current workforce analysis, planning and implementation

Continue to access and apply current workforce analysis, planning and implementation


3c Explore and understand how PC is delivered by Allied Health providers and by Maori organisations and other ethnic minority providers




NETWORKING AND ENGAGEMENT

To support consumer participation and decision making about Palliative and End of Life Care at every level in the SI.

4 To get a better understanding from consumers and Maori on their experience of End of life and Palliative Care services in the South Island based on information obtained from the patients and their family/whanau’s experience, including key socio-demographic variables

Q4 Continue to demonstrate communication with Consumers and Maori on their experience of End of life and Palliative Care services in the South Island

Continue to demonstrate communication with Consumers and Maori on their experience of End of life and Palliative Care services in the South Island




Cardiac Services

South Island people enjoy quality of life and are prevented from dying prematurely from heart disease.


Clinical Lead: Dr David Smyth, Cardiologist & Clinical Director of Cardiology (Canterbury DHB)

The Cardiac Services Workstream has been formed to provide regional leadership across the South Island Cardiac

continuum of care through:

A supported and planned approach of coordination and collaboration across the delivery of service.

Reducing inequalities in access to cardiology services across the South Island.

Enhancing the quality of cardiac health services across the South Island.

Utilising common referral, prioritisation and condition management tools.

Ensuring the sustainable management of cardiac services in the South Island.

Nine key focus areas set the direction of this work plan:

South Island Model of Care

Equity of Access

Meeting National Indicators

Heart Failure

Workforce Training

Minimum Facilities Guidelines

Transporting of Cardiac Patients


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES


Cardiac Services Workstream SOUTH ISLAND MODEL OF CARE

Complete project work associated with the South Island Cardiac Model of Care

1 South Island Cardiac Model agreed and implemented consistently in the region (subject to resource constraints).

South Island Cardiac Model of Care is acknowledged as providing improved and more efficient services

South Island Cardiac Model of Care is acknowledged as providing improved and more efficient services

Workstream members and co-opted expertise on various projects required to complete the model

Access to tests

2a Determine current access and utilisation of cardiac tests in primary, secondary and tertiary services

Q2 Cardiac Workstream

2b Prepare guidelines to ensure equity of cardiac tests


2c All South Island DHBs recording and storing ECGs (subject to finance and business case approval)

Q2

Maintain common regional method of storing and sharing ECGs

Maintain common regional method of storing and sharing ECGs

Cardiac Services workstream, with support/advice from IS SLA

Optimal HealthPathways

3a Determine current access to and utilisation of HealthPathways in primary, secondary and tertiary services

Q2

3b Implement and utilise appropriate HealthPathways which ensure equity of access throughout the region





ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

3c Percutaneous Coronary Intervention regional health pathway implemented

Q2 Report on regional pathway usage

Report on regional pathway usage

Cardiac Workstream

3d Common Accelerated Chest Pain pathway implemented in South Island hospitals

Q2 Report on regional pathway usage

Report on regional pathway usage

Cardiac Workstream

Planning for sustainability

4 Report on and provide recommendations regarding the optimal mix of cardiac services for the South Island


EQUITY OF ACCESS

Ensure access to angiography for high risk populations group such as Māori, Pacific and South Asian people

Strategies to support access to angiography for Māori, and other high risk population groups

5 Monitor access rates for high risk population groups

Cardiac Workstream

MEETING NATIONAL INDICATORS Improved outcomes for people with suspected Acute Coronary Syndrome

Standardised intervention rates for ACS patients

6 Support South Island DHBs to address any challenges that arise with providing appropriate cardiac care and meeting standardised intervention rates.

In addition, report on:

>70% of high-risk ACS patients accepted for coronary angiography having it within 3 days of admission. (‘Day of Admission’ being ‘Day 0’)

>95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS QI ACS & Cath/Percutaneous Coronary Intervention (PCI) registry data collection, within 30 days

Percutaneous revascularisation (12.5 per 100,000 population)

Coronary angiography (34.7 per 10,000 population)

(all South Island hospitals record and report data monthly through ANZACS QI register)

Q1, Q2, Q3, Q4

Continued achievement of national indicators as determined by/modified by National Health Board in conjunction with the National Cardiac network.

Continued achievement of national indicators as determined by/modified by National Health Board in conjunction with the National Cardiac network.

DHBs and Cardiac Workstream

Cardiac surgery targets achieved which will improve equity of access as identified and agreed by The National Cardiac Network

7 Support South Island DHBs in the continued achievement of national indicators around equity of access.

In addition, report on:

Standardised cardiac surgery rates (6.5 per 10,000 population)

Proportion of patients scored using the national cardiac surgery Clinical Priority Access (CPAC) tool, and proportion of patients treated within assigned urgency timeframe

The waiting list for cardiac surgery remains between 5% and 7.5% of planned annual cardiac throughput, and does not exceed 10% of annual throughput

Patients wait no longer than four months for a cardiology first specialist assessment, or for cardiac surgery

Continued achievement of national indicators as determined by National Health Board in conjunction with the National Cardiac network.

Continued achievement of national indicators as determined by/ National Health Board in conjunction with the National Cardiac network.

DHBs and Cardiac Workstream




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

Over 95% of patients undergoing cardiac surgery will have completion of Cardiac Surgery registry data collection within 30 days of discharge

HEART FAILURE

Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of patients with heart failure.

8 Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of patients with heart failure (within available resources). The Model of Care projects will identify best practise processes and enable sharing these across the South Island.

Continued achievement of national indicators as determined by/modified by National Health Board in conjunction with the National Cardiac network

Continued achievement of national indicators as determined by/modified by National Health Board in conjunction with the National Cardiac network

Cardiac Services workstream

WORKFORCE TRAINING

Workforce training maintained

Opportunities for training in echocardiography identified

9 Implement recommendations formed in 2015/16 in conjunction with National Network (subject to resource constraints)

Continued uptake of education opportunities


Cardiac Services workstream, with support/advice from SIWDH

Regional coordination and development of Inter - professional learning

Ensure the workstream is well connected with National Network and MoH

10 Continued achievement of national indicators around inter-professional learning as determined by National Health Board in conjunction with the National Cardiac network

Continued achievement of national indicators as determined by National Health Board in conjunction with the National Cardiac network

Continued achievement of national indicators as determined by National Health Board in conjunction with the National Cardiac network


A regional approach to cardiology nurse training developed in collaboration with the South Island Regional Training Hub.

Initial focus to include:

-increased exposure to cardiology during nursing training

-training opportunities in New Zealand for Clinical Nurse Specialists in Cardiology.

11 Regional subgroup of cardiac nurse educators continues to meet quarterly Agree and implement a draft plan developed by CDHB staff



Cardiac Nurse Educator in each district and Facilitator, with support/advice from SIWDH

MINIMUM FACILITIES GUIDELINES

Review and update minimum facilities guidelines

12 Guidelines agreed in 2013 to be reviewed and updated if required (2 year cycle)

Guidelines agreed in 2015 to be reviewed and updated if required (2 year cycle)


TRANSPORTING OF CARDIAC PATIENTS

Regionally agreed guidelines for the arranged transportation of cardiac patients

13 Guidelines for transporting cardiac patients agreed in 2013 and updated 2015/16 are consistent for the South Island

Guidelines agreed in 2015 to be reviewed and updated if required (2 year cycle).


Develop regionally agreed guidelines for transporting/retrieving of emergency/acute patients

14 Report developed and endorsed by key stakeholders, based on meeting the less than 90 minute transport/retrieval time

Maintain improved transfer times

Maintain improved transfer times

Cardiac Services workstream with particular involvement of St John



Elective Services

Sustainable, equitable elective services for South Islanders

Sponsor: General Managers Planning and Funding (South Island DHBs)

Chief Operating Officers (South Island DHBs)

The South Island Alliance Elective Services Workstream is overseen by GMs Planning & Funding and Hospital General

Managers, while each area of focus is supported by a work group that is clinically led. The Elective Services Workstream

will:

Explore elective service delivery across the South Island focussing on:

Population need and projections

Options to support clinically and financially sustainable service delivery into the future.

Take a health system approach, and analyse secondary and tertiary referral elective services (variability of delivery,

capacity, capability, sustainability)

Prioritise services for attention to future configuration and delivery of elective health services across the South

Island, using clinical and management tools such as HealthPathways, consistent systems and processes

Two key focus areas set the direction of this work plan:

Regional/Sub-regional collaboration in:

Inter-district flows

Urology

Bariatric surgery

Cardiac model of care

Infertility

Plastics services

Vascular services

Eye health services

Maxillofacial services

Reducing disparities


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES


Elective Services INTER-DISTRICT FLOWs

South Island Inter-district flows modelling and capacity planning to sustainably manage acute and elective, secondary and tertiary delivery

1a Complete demand analysis, including consideration of demographics, forecasting volumes, infrastructure and workforce.

Q2 Electives Steering Group

1b Complete supply analysis, including forecasting of South Island capacity


Agree and implement the regional delivery of electives discharges towards meeting the electives health target (Budget 2016)

Q2, Q4 Electives Steering Group

1c Develop models of care and appropriate pathways, incorporating clinical, business and information processes

Q4 Electives Steering Group and CMOs

UROLOGY 2 Implement consistent clinical protocols for

urology conditions in interested DHBs Q2 Urology Project Group




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

3 Implement urology online Lippincott Procedures

Q2 Urology Nursing Group

INFERTILITY SERVICES

4 Fully operationalize the service across the South Island, including implementing the single South Island waiting list


PLASTICS SERVICES

5a Quantify demand for plastics services (all services, 2015/16 demand; projected demand to 2019/20)

Q2, Q4 Plastics Services Project Group and Electives Steering Group

5b Describe evidence-based plastics services and workforce models across the spectrum of care (international, NZ, SI)

5c Identify and quantify variations between Plastics Services HealthPathways across the South Island

5d Establish an agreed South Island plan to implement the national Plastics prioritization tools in 2016

5e Recommend Plastics Services service and workforce model(s) for the South Island that support equity of access and sustainable service delivery across the region

5f Recommend a transition pathway, including resource implications, to achieve the desired model(s)

VASCULAR SERVICES

6 Implement the nationally agreed Vascular Services model of care in the South Island (subject to resource constraints)

Q2, Q4 Vascular Services Project Group, Electives Steering Group

EYE HEALTH SERVICES

7a Quantify demand for eye health services (all services, 2015/16 demand; projected demand to 2019/20)

Q2, Q4 Eye Health Services Project Group, Electives Steering Group

7b Describe evidence-based eye health service and workforce models across the spectrum of care (international, NZ, South Island)

7c Identify and quantify variations between eye health HealthPathways across the South Island

7d Establish and agree SI plan to implement the Cataract prioritisation tool in 2016

7e Recommend eye health service and workforce model(s) for the South Island that support equity of access and sustainable service delivery across the region

7f Recommend a transition pathway, including resource implications, to achieve the desired model(s)

MAXILLOFACIAL SERVICES

8 Agree a sustainable South Island plan for Maxillofacial Services





ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

REDUCING DISPARITIES

9 Identify baseline for Maori access (current and evidence) in selected priority areas.


10 Collate and share innovations in the selected service areas via best practice documents and use of HealthPathways

Q2, Q4 Each project group

Work supported by the Elective Services Workstream

The Elective Services Workstream is committed to supporting work led by other SLAs/Workstreams or individual DHBs where appropriate. In particular, the Workstream will support South Island DHBs to deliver timely care to their patients and meet the Elective Services Health Target through collaboration and sharing of best practice to address and overcome issues as they arise. The work on inter-district flows is an example of this.

National and regional initiatives supported by the Elective Services Workstream, but led by other SLAs/Workstreams or individual DHBs

South Island Cardiac Model of Care (page 53, items 14a &14b) Owner: Cardiac Services Workstream Improve access to elective services Delivery against agreed volume schedule, including elective surgical discharges, to deliver the Electives Health Target Owner: Individual South Island DHBs Reported: Individually by the South Island DHBs quarterly Maintain reduced waiting times for elective first specialist assessment and treatment Elective Services Patient Flow Indicators expectations are met, and patients wait no longer than four months for first specialist assessment and treatment, and all patients are prioritised using the most recent national tool available. Owner: Individual South Island DHBs Reported: Individually by South Island DHBs quarterly



Major Trauma services

More patients survive major trauma and recover with a good quality of life

Sponsor: David Meates, CEO (Canterbury DHB)

Lexie O’Shea, Executive Director of Patient Services (Southern DHB)

Clinical Lead: Dr Mike Hunter, Clinical Leader ICU (Southern DHB)

The South Island Major Trauma Workstream has been formed to provide Regional Leadership across the Major

Trauma continuum of care through:

A planned and consistent approach to the provision of major trauma services across New Zealand.

Eight key focus areas set the direction of this work plan:

South Island Major Trauma Services systems and processes agreed to support people surviving major trauma and

recovering with a good quality of life

Establishing systems to collect NZ Major Trauma Minimum Dataset and NZ Major Trauma Registry

Clinical Leadership

Workforce

Networks

Destination policies

Inter hospital transfer protocols

Spinal cord impairment action plan


ITEM NO


APPROVED

SCHEDULE DELIVERABLE

2017-2018

DELIVERABLE



Major Trauma Workstream SOUTH ISLAND REGION MAJOR TRAUMA PLAN

South Island Major trauma regional action plan reviewed and updated

1 a South Island region focuses on implementation of local and regional trauma systems

Q1, Q2, Q3, Q4

Baseline reporting against the defined performance indicators.

Report quarterly against the regional workplan.

Annual Report for the region for the period ending June 2017 is prepared and presented

Baseline reporting against the defined performance indicators.

Report quarterly against the regional workplan

Major Trauma Workstream

1 b South Island region reports major trauma using the agreed national minimum dataset

Q1, Q2, Q3, Q4

Consideration to extending data collection to moderate and minor data as well

Consider research and academic opportunities with available data


NZ MAJOR TRAUMA MINIMUM DATASET

System established for South Island region major trauma data collection

2 South Island data collection and input into national major trauma registry commenced 1 July 2016

Q1, Q2, Q3, Q4


South Island region trauma definitions aligned to those used in the NZ Major Trauma Minimum Dataset (NZMTMD)

3 Local trauma definitions aligned with those used in the NZMTMD.

Q1, Q2, Q3, Q4





ITEM NO


APPROVED

SCHEDULE DELIVERABLE

2017-2018

DELIVERABLE


NZ MAJOR TRAUMA REGISTRY

South Island DHBs participate in the implementation and roll-out of the national major trauma registry

4 National major trauma registry available and implemented across the South Island using Midland’s Registry and Collector™ software.

Q1, Q2, Q3, Q4

Major Trauma Workstream, with assistance from SI IS SLA

CLINICAL LEADERSHIP

South Island DHBs major trauma clinical leaders; co-ordinators; and administrators appointed

5 Responsibilities identified and assigned for Clinical lead and coordinator roles in each DHB

Q1 Continued clinical lead and coordinator roles in each DHB

Continued clinical lead and coordinator roles in each DHB

Major Trauma Workstream,

WORKFORCE

Regions and DHBs are encouraged to explore opportunities for additional experience to be provided to trauma care providers at centres with more exposure to major trauma management.

6 Training plans developed by each DHB to ensure relevant clinical staff are appropriately trained in trauma care

Q2 Implementation of Training plan Implementation of Training plan

Major Trauma

DESTINATION POLICIES

Agree Regional Destination Policies in collaboration with DHBs, Ambulance and Air Transport providers

7 Develop, assess and understand implications of Regional Destination Policies, with a view to implementing these, in collaboration with DHBs, Ambulance and Air Transport providers

Q2 Regional Destination Policies maintained

Potential in conjunction with transfer policies for on-line regional health pathway to be developed


INTER-HOSPITAL TRANSFER PROTOCOLS

Development and implementation of inter-hospital transfer protocols.

8 Develop, assess and understand implications of Inter-hospital transfer protocols, with a view to implementing these subject to resources constraints

Q2 Inter-hospital transfer protocols maintained

Potential for on-line regional health pathway to be developed


SPINAL CORD IMPAIRMENT ACTION PLAN

Acknowledge SI DHBs’ intentions regarding MoH requirements as outlined in the New Zealand Spinal Cord Impairment Action Plan 2014-2019.

9 Maintain awareness of:

- work to establish acute supra regional spinal services and early rehabilitation pathways (led by Canterbury DHB)

- other SI DHBs implementation of agreed nationally directed destination and referral processes for acute spinal cord injuries and work with supra regional spinal services

Ongoing Note progress Note progress CDHB



Public Health Services

A healthier South Island population through effective regional and local delivery of core public health functions

Sponsor: Andrew Lesperance, GM Strategy, Planning and Alliance Support (Nelson Marlborough DHB)

Clinical Lead: Dr Ed Kiddle, Medical Officer of Health (Nelson Marlborough DHB)

The South Island Public Health Partnership has been formed to:

Sustain effective and efficient regional and local delivery of Ministry-funded Public Health Unit (PHU) services.

Improve the interface and support between PHUs and other parts of the health system.

Support population health approaches and planning.


Māori

Quality

Environmental sustainability

Health in all policies – environmental determinants of health

Rheumatic fever


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES


PUBLIC HEALTH MĀORI

Support and develop a Māori voice within the South Island Alliance

1 Work in partnership with Te Herenga Hauora to develop key messages on South Island priority public health issues as they pertain to Māori

Q2, Q4 Continue to strengthen this approach

Yet to be determined Contributors: SI PHP Management group, Māori GMs (Te Herenga Hauora)

Reported in: SIHSP

Increase awareness of the key Māori public health issues in the South Island

2 Review of the key public health issues for Māori in the South Island

Q1,2 Selection of a priority public health issue for Māori for a collaborative approach

Yet to be determined Contributors: SI PHP Management group, Māori GMs (Te Herenga Hauora)

Reported in: SIHSP

QUALITY

System development

3 Development of a results based accountability approach for public health planning in the South Island

Q4 Implementation, evaluation and further development

On-going evaluation and development

Contributors: SI PHP Management group, SI Quality and Safety SLA, Health Quality and Safety Commission

4 Development of a quality framework for public health services

Q4 Implementation, evaluation and further development

On-going evaluation and development

Contributors: SI PHP Management group, SI Quality and Safety SLA, Ministry of Health, Health Quality and Safety Commission

ENVIRONMENTAL SUSTAINABILITY

Increased awareness around environmental sustainability and the co-benefits of action in this area for population health

5 Completion of a stocktake of environmental sustainability initiatives across South Island DHBs

Q2 Develop and implement and promote a plan to address the gaps

Yet to be determined Contributors: Support Services SLA, SIPHP Management group




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

6 Prepare environmental sustainability policy/position statement

Q4 Promote awareness of the policy/position statement once Boards endorse

On-going promotion Contributors: SI Public Health Analysts Network, Support Services SLA,

Reported in: SIHSP

7 Promotion of consistent environmental sustainability monitoring systems

Q4 Information is utilised to develop projects

Yet to be determined Contributors: SI PHP Management Group, Support Services SLA

HEALTH IN ALL POLICIES (HiAP)

Actively promote a HiAP approach towards the environmental determinants influencing healthy weight, oral health, clean air, warm homes and alcohol harm reduction

8 Development of South Island position statements within the following areas:

Water fluoridation

Air quality and warm homes

Sweetened drinks

Sustainability

Q1, Q2, Q3, Q4

Promote aware of the position statements once Boards endorse

On-going promotion Contributors: SIPHP Management group, SI PHP Facilitator, SI Child Health SLA, SI PH Analysts , SI DHBs, SI Hospital Dentists

Reported in: SIHSP

9 Identification of further regional approaches / combined initiatives to promote healthy eating and active lifestyles

Q2,4 Undertake initiatives identified in 16/17

Yet to be determined Contributors: SI PH Analysts network, Child Health SLA

Reported in: SIHSP

10 Explore the impact and learnings from the two Healthy Families NZ projects in the SI to contribute to wider South Island PHU/DHB efforts

Q1,3 To be determined in response to the findings in 2016-17

Yet to be determined. Current projects due to end in June 2018.

Contributors: PHS/SDHB, CPH/CDHB , Child Health SLA & SI PHP Management group

Reported in: SIHSP

11 Contribution of a regional population health perspective to the Alcohol Harm Reduction ED Project

Q1,Q3 Yet to be determined. Yet to be determined Contributors: Si PHP management Group, Child Health SLA, Health Promotion Agency

RHEUMATIC FEVER

South Island Rheumatic fever cases monitored

The Partnership supports DHBs to have mechanisms in place to ensure the Rheumatic Fever Prevention and Management Plan is implemented as intended

12 Ongoing monitoring and collective South Island public health response to results

Q2, Q4 Surveillance reports continue to show Rheumatic Fever case numbers and disease rates across the South Island

Surveillance reports continue to show Rheumatic Fever case numbers and disease rates across the South Island

Contributors: SI Medical Officers of Health via SI PHP Management group.

Reported in: SIHSP



Stroke Services

Delivering Organised Stroke Services - Best stroke care, everywhere

Clinical Lead: Dr John Fink, Clinical Director Neurology (Canterbury DHB)

The South Island Stroke Workstream has been formed to:

Support the implementation of organised stroke services locally and regionally across the South Island and thereby

encourage consistency and sustainability in the provision and delivery of acute and rehabilitation stroke services

(organised stroke services have been shown to improve the health outcomes of those who have a transient

ischaemic attack (TIA) or stroke).


Primary and secondary stroke prevention and reduced stroke related disability and mortality

Access to high quality stroke services

Rehabilitation and community stroke services

Workforce education and training


ITEM NO

DELIVERABLE 2016 -2017

APPROVED SCHEDULE



RESPONSIBILITIES


Stroke Services

Primary and secondary stroke prevention and reduced stroke related disability and mortality

1 Each SI DHB has a system to rapidly confirm a diagnosis of stroke and identify patients who may benefit from thrombolysis and improve door to needle time to 60 minutes

Note: Average door-needle time for SI is 82 minutes, similar to other regions in NZ but greater than current NZ target of 60 minutes

Q2

Q4

Each SI DHB has a system to rapidly confirm a diagnosis of stroke and identify patients who may benefit from thrombolysis therapy implemented in each SI DHB

Each SI DHB has a system to rapidly confirm a diagnosis of stroke and identify patients who may benefit from thrombolysis therapy implemented in each SI DHB

SI Stroke Workstream,

DHBs,

St John

2 Every hospital providing organised stroke care in the South Island has a Lead Stroke Nurse with assigned non clinical hours who works in the Stroke Service.

Q4 Each SI DHB has a designated Lead Stroke Nurse who has assigned non clinical hours to achieve the Stroke Nurse role. Including developing and improving the Stroke Service. (In small centres it may not be a fulltime position)

Each SI DHB has a designated Lead Stroke Nurse who has assigned non clinical hours to achieve the Stroke Nurse role. Including developing and improving the Stroke Service. (In small centres it may not be a fulltime position)


DHBs

Access to high quality stroke services

3 Achieve 6% compliance for thrombolysis of eligible stroke clients.

Thrombolysis register is used in a consistent manner in SI DHBs and reported nationally

Q2

Q4

Achieve 8% compliance for thrombolysis of eligible stroke clients

Achieve 8% compliance for thrombolysis of eligible stroke clients


DHBs

4 Facilitate the delivery of Organised Stroke Care (defined by National Stroke Network) in each South Island DHB.

Achieve 80% compliance for stroke patients to be cared for in organised stroke unit.

Q2

Q4




DHBs

5 Monitor stroke ethnicity data and geographic domicile and report regionally

Q2

Q4

Monitor stroke ethnicity data and geographic domicile and report regionally. Identify trends

Monitor stroke ethnicity data and geographic domicile and report regionally. Identify trends


DHBs




ITEM NO

DELIVERABLE 2016 -2017

APPROVED SCHEDULE



RESPONSIBILITIES

Rehabilitation and community stroke services

6 South Island DHBs deliver inpatient and community stroke rehabilitation services which reflect best practice and are regionally consistent.

Supporting this deliverable will be work on the following measures:

80% of patients admitted with acute stroke who are transferred to in-patient rehabilitation services are transferred within 7 days of acute admission.

Explore a consistent mechanism to measure the proportion of patients admitted with stroke who receive a face to face community rehabilitation session within 7 days after in-patient discharge (with a view to being ready to measure in 2017-18).

Q2,Q4

Q1,2,3,4

Q4

Community rehabilitation is available to aid adjustment and minimise complications.

Community rehabilitation is available to aid adjustment and minimise complications.

SI Stroke Workstream, DHBs

Ongoing education and training for interdisciplinary stroke team

7 South Island Stroke teams have a minimum of 8 hours stroke specific education per year (minimum standard)

Stroke teams have access to a range of educational opportunities (regional and local) to support continued development of knowledge and skill in delivering best practice stroke services

Q2,Q4 South Island Stroke teams have a minimum of 8 hours stroke specific education per year (minimum standard)

Appropriate educational opportunities are promoted to primary care, community teams, Age Residential Care, Acute and Rehabilitation teams

South Island Stroke teams have a minimum of 8 hours stroke specific education per year (minimum standard)

Appropriate educational opportunities are promoted to primary care, community teams, Age Residential Care, Acute and Rehabilitation teams


DHBs



Hepatitis C Workstream

Clinical Lead: Dr Alan Pithie (Canterbury DHB)

The Hepatitis C Workstream is newly formed in order to design and implement integrated assessment and treatment

services for Hepatitis C in the South Island.

The membership of the South Island Hepatitis C Workstream is confirmed, and an assessment of the clinical and diagnostic

capacity and capability requirements in the South Island has been carried out.

The focus of this workplan will be to:

Develop a clinical pathway for Hepatitis C patients (based on national developments on the availability of

treatments and guidance from the Ministry of Health)

Agree a business case for the ongoing provision of Hepatitis C services

Supporting national awareness programmes and education for health professionals

Milestones Dashboard 2016-9

ITEM NO

DELIVERABLE

2016-2017

APPROVED SCHEDULE

DELIVERABLE

2017-2018

DELIVERABLE



Hepatitis C

Integrated Hepatitis C Assessment and Treatment Services

1 Develop an agreed clinical pathway through engagement with primary and secondary sectors across the region based on guidance provided by the Hepatitis C Implementation Advisory Group.

Q1

Hepatitis C Workstream

2 With MoH, develop an agreed business case to identify the costs of ongoing delivery of Hepatitis C services

Q1 Hepatitis C

Workstream

3 Complete implementation planning

Q1 Hepatitis C Workstream

4 Appoint a Co-ordinator to drive the hepatitis C programme (subject to resourcing) in the South Island

Q2 Hepatitis C

Workstream

5 Promote and implement the hepatitis C clinical pathway Q2 Hepatitis C

Workstream

6 Direct testing toward people at increased risk Q2 Hepatitis C

Workstream

7 Support the national campaign to raise community awareness of hepatitis C and risk factors for infection

Q3 Hepatitis C

Workstream

8 Support the national GP awareness and education programme Q3 Hepatitis C

Workstream

9 Monitor and report on hepatitis C measures

Q2 and Q4 Hepatitis C Workstream



Quality and Safety Services

Supporting South Island DHBs to make a positive contribution to patient safety and the quality of care

Clinical Lead: Mary Gordon, Executive Director of Nursing and Midwifery (Canterbury DHB)

The Quality and Safety SLA has been formed to:

Lead, advise and make recommendations to support and coordinate improvements in safety and quality in health

care for the South Island DHBs.

Identify and monitor initiatives that support improvements in national health and safety indicators.

Report on safety and quality, including performance against national indicators.

Share knowledge about and advocate for, safety and quality.


Infection Prevention and Control

Partners in Care

Clinical Governance

Promoting safety frameworks – Safety 1st

Emerging priorities


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

KEY ENABLERS

Quality and Safety

Infection Prevention and Control

Safe Surgery New Zealand

1 SI DHBs implement the new Quality and Safety Marker as part of the Safe Surgery New Zealand HQSC programme

Q4 Contributors: SI DHBs supported by Quality and Safety SLA

Reported in: SIHSP

Individual DHBs will be responsible for reporting their own QSM audit results

ICNet (Infection Control)

2 SI DHBs understand the capabilities of ICnet and determine the direction for the use of ICnet in the SI DHBs

Q4 Contributors: Quality and Safety SLA

Reported in: SIHSP

Regional Infection Prevention and Control work shops

3 Regional SI DHB Infection Prevention and Control workshops are held

Q4 Contributors: SI DHBs supported by Quality and Safety SLA

Reported in: SIHSP

PARTNERS IN CARE

Consumer Engagement

4 Effective Consumer engagement in the SIA and South Island DHBs

Q4 Undertake further stocktake of consumer engagement to understand progress since the 2015/16 stocktake

Contributors: Quality and Safety SLA and SI DHBs

Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

CLINICAL GOVERNANCE

5

Place holder:

Clinical governance framework (specific details of this are subject to the outcome of the HQSC work 2015/2016)

Q4 Contributors: Quality and Safety SLA

Reported in: SIHSP

PROMOTING SAFETY FRAMEWORKS

Safety1st

6a Provision of ongoing governance to Safety1st

Q4 Provision of ongoing governance to safety1st

Provision of ongoing governance to safety1st

Contributors: Quality and Safety SLA

Reported in: SIHSP

6b Safety1st Control Group (made up of representatives from each DHB) meet monthly to discuss Satety1st

Q4

6b Ongoing regional support for Safety1st is established

Q4

6c Enhancement and rollout of additional Safety1st modules:

Risk Module

Hazard Module

RCA Module

Q4 Patient Feedback (subject to successful resource request)


Reported in: SIHSP

6d Consistent regional SI DHB Safety1st taxonomy

System admin position/role descriptions or similar document

Regional policies and change request forms

Q4

6e Provide regional SI DHB Safety1st reports

Q4 Regional SI DHB Safety1st reports

Regional SI DHB Safety1st reports

Contributors: SI DHBs supported by Quality and Safety SLA

Reported in: SIHSP

6f 1. Business case and framework for the roll out of Safety1st into primary care and community providers

(Subject to approval of the resource request for a project manager)

2. Safety1st rolled out into primary care and community providers (Subject to the recommendations of the business case)

Q3

Q4


Reported in: SIHSP


Reported in: SIHSP

6g Scoping of a national RL Solutions user group

Q4

EMERGING PRIORITIES

The Deteriorating Patient

Support SI DHBs with the work on the Deteriorating patient (HQSC initiative)

Pressure Injury Prevention

Support SI DHBs with the work on Pressure Areas (HQSC initiative)



Work supported by the Quality and Safety Service Level Alliance

National projects supported by Quality and Safety

Health Quality and Safety Commission priorities including falls, hand hygiene, SSI and Medication Safety are individually reported on

by the South Island DHBs. The South Island Patient Safety Campaign work group is responsible for driving a regional approach to the

national programme, they report to the Quality and Safety SLA.

The Health Quality and Safety Commission is actively engaged with the Quality and Safety SLA.

Regional projects enabled by Quality and Safety, but led by other SLAs and Workstreams

Inter-professional Learning (Item 1a & 1b, page 72) Owner: South Island Work force Development Hub

Falls Prevention (Item 8, page 48) Owner: Health of Older Persons SLA



South Island Information Services

Lead CEO: Nigel Trainor (South Canterbury DHB)

Clinical Lead: Andrew Bowers, Medical Director, Information Technology & Physician (Southern DHB)

Programme Director: Paul Goddard (South Island Alliance Programme Office)

Information Technology provides the platform to support improved information sharing that enables new models of care and better decision making. Well-designed Information Technology systems will help the South Island to work smarter to reduce costs, support care pathways and give patients better, safer treatment. Greater reliance on technology requires effective management of Information Technology investments, implementations and ongoing operations. Sustained investment in Information Technology is one of the ways to manage increasing demand with limited resources.

The Information Services, Service Level Alliance has been formed to:

Oversee the Information Services portfolio of work

Provide overarching governance to the South Island Information Technology programme and projects

Provide a point of escalation for the resolution of issues if the Programme or Projects vary from planned time, cost or scope

The Information Services, Service Level Alliance is implementing an information supported clinically led approach to patient care. With guidance from the National Health IT Board, the Information Services, Service Level Alliance has developed a portfolio of projects and programmes. Initial emphasize has been on establishing the regional platform by the systematic replacement of our legacy systems with the standardised regional solutions of Health Connect South, HealthOne, South Island Patient Information Care System, eReferrals Management and eMedicines Management. As these projects begin to transition from implementation into the business as usual phase the Information Services, Service Level Alliance can begin to implement additional building blocks to provide a foundation platform to support the delivery of care across the whole system.

The continued implementation of the portfolio is outlined within this Health Service Plan. This has been developed into a long term plan to address the priorities that the Alliance has identified. The 2016-17 Information Services Service Level Alliance workplan has been developed in line with the Ministry of Health’s five year (2015-2020) Health IT Programme focus areas.


eHealth Records

Digital hospitals

Health Data

Preventive Care

The South Island is progressing the implementation of electronic solutions across the whole of the South Island health system that will provide better, safer, more efficient healthcare.

The IS SLA programme of work is supporting the vision of enabling clinicians and health providers to have access to health information where and when they need it this will support clinical decision making at the point of care. Across the South Island we are working to actively implement well-designed, easy to use solutions, we are developing these in consultation with our clinical leaders to support clinical workflow requirements, linked to smarter, safer health care delivery.

The IS SLA recognise that for information sharing and integrated services to work well it takes a team approach across the whole of the health system. As a core component of the alliance model we are clinically driven and supported by strong leadership and working in partnership with patients and vendors.

The IS SLA outcomes for implementing health informatics solutions is that they must ensure that people wait less, no wasted resource and that people are protected from harm or needless death.



As part of the SI commitment to delivering on the Minister of Health’s4 electronic health record vision the IS SLA programme of work will enable and support:

Quality and productivity benefits to be realised through rationalising and eliminating duplication and replication of patient information across multiple systems and services through the consolidation and delivery of a single SI unified electronic health record;

Creation of the SI unified electronic health record, that physically consolidates health information in one place, will improve decision support and care coordination especially for complex patients with multiple long-term conditions;

A whole of system approach Primary Care will be incorporated into the SI unified electronic health record;

The implementation of the eMedicines programme the SIA will enable the highest benefits in terms of patient safety and quality;

The integration of consumer Portal access into the SI health system to deliver care closer to home. This leverages the ability to serve up information from a physical repository in real-time.


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

KEY ENABLERS

INFORMATION SERVICES eHEALTH RECORDS

HEALTH CONNECT SOUTH PROGRAMME

Regional Programme

Southern HCS Implementation

1 Complete Southern DHB’s Health Connect South implementation.5

Q1

Lead: Regional Programme Manager SIAPO Reported in : SIHSP

2 Project closure for SDHB Health Connect South implementation

Q2


Nelson Marlborough HCS Implementation

3 Project closure for NMDHB Health Connect South implementation

Q1


Mental Health

4 Mental Health solution requirements agreed for SI DHBs

Q1 Phased implementation of SI Mental Health solution commences


5 Pilot the Mental Health solution in one SI DHB Q3

HEALTHONE

HealthOne enables pharmacists and other authorised clinicians to view patient information that is shared between multiple healthcare providers, including test results, allergies, prescribed and dispensed medications together with hospital information

6 Complete the roll-out of HealthOne to SDHB Q2 Project closure Lead: Regional Programme Manager SIAPO Reported in : SIHSP

7 Complete the implementation of HealthOne for Marlborough PHO (NMDHB)

Q2

4 Jonathan Coleman Health Informatics New Zealand Conference, Christchurch , 20 October 2015 5 Dependency on SMT solution

Note – the workplan is tentative pending budgeting and resourcing decisions.




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

SOUTH ISLAND PATIENT INFORMATION CARE SYSTEM (PICS)

Alerts and Warnings

8 Have an agreed solution and process for managing Alerts and Warnings across the South Island

Q4

Business case approved and implementation commenced

Project closure Lead: Regional Programme Manager SIAPO Reported in: SIHSP

eMEDICINES PROGRAMME

ePrescribing and Administration (ePA)

Implementing ePA into inpatient wards across the South Island DHBs (incorporating NZULM & NZ Formulary when sources are available) with the aim of improving medication safety for patients whilst an inpatient

9 Canterbury DHB ePrescribing and Administration project completed

Q2 Lead: Regional

Programme Manager SIAPO Reported in: SIHSP

10 West Coast DHB ePrescribing and Administration project planning and implementation commenced

Q4

West Coast DHB ePrescribing and Administration project completed

11 Nelson Marlborough DHB ePrescribing and Administration project planning and implementation commenced

Q4

Nelson Marlborough DHB ePrescribing and Administration project completed

eMedicine Reconciliation (eMR)

Implementing electronic Medication Reconciliation across South Island DHBs. eMR helps health professionals create the most accurate and up-to-date list available of a patient’s medicines on presentation to hospital (incorporating NZULM & NZ Formulary when sources are available)

12 Deployment of eMR to CDHB completed Q2

Implementation continues across remaining DHBs


13 Phased implementation commenced (starting with WCDHB) across the SI DHBs

Q4

TELEHEALTH

To scope and define a TeleHealth regional direction for the South Island

14 Agree and define a South Island definition of Telehealth

Q4

Provide the SI DHBs with an agreed telehealth framework that identifies minimum SI standards when implementing a telehealth strategy.

Lead: IS SLA Reported in: SIHSP

15 Agree concepts of telehealth to be addressed and prioritise order for completion

NATIONAL ELECTRONIC HEALTH RECORD

Integration with the National EHR

16 Emerging/placeholder further detail maybe provided Engage with the national programme to establish sector requirements and develop the roadmap for an EHR environment

Q4

Support the integration of SI systems with the national EHR implementation

Continue to support the national EHR implementation


CLINICAL OBSERVATIONS PLATFORM (Contingent on the approval of funding request)

To implement an e-observations platform for the capture of vital signs and clinical data

17 Scope and agree SI requirements for a clinical measurements platform

Q4

Regional Business case approved. Phased implementation of an e-measurements platform across the SI DHBs commenced.

Implementation completed Lead: IS SLA Reported in: SIHSP

DIGITAL HOSPITALS

eREFERRALS PROGRAMME

Stage 1

Regional implementation of Stage 1. eReferrals received by ERMS via fax

18 Project closure and implementation reviewed completed

Q3

Lead: Regional Programme Manager SIAPO Reported in: SIHSP

Stage 2

eReferrals received through the RMS module in Health Connect South

19 Complete regional Stage Two implementation of eReferrals for NMDHB

Q3




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

20 Complete regional Stage Two implementation of eReferrals for SDHB

Q4 Lead: Regional


21 Project closure and implementation reviewed completed

Q4

Stage 3

Implementation eTriage - eReferrals received through the RMS module in Health Connect South with triage functionality

22 Regional eTriage Business case approved Q1 Project closure and implementation reviewed completed


23 Phased implementation commenced across all SI DHBs Q4

SOUTH ISLAND PATIENT INFORMATION CARE SYSTEM (PICS)

Canterbury DHB Implementation

24 Prepare for implementation into the balance of Canterbury DHB sites

Q4

Implement SI PICS into other Canterbury DHB sites


Nelson Marlborough DHB Implementations

25 Project go-live for Nelson Marlborough DHB

Q4


South Canterbury DHB Implementation

26 Prepare for SI PICS Implementation

Q4

Implement SI PICS Lead: Regional Programme Manager SIAPO Reported in: SIHSP

West Coast Implementation

27 Prepare for SI PICS Implementation

Q4


Southern DHB Implementation

28 Support the development of SDHB implementation business case for SI PICS

Q4

Prepare for SI PICS Implementation


ED Information Solution

Provide a regional solution to support visibility of ED activity

29 Progress with defining requirements and scope for a regional ED solution

Phased implementation of the ED information solution across the SI DHBs (commencing with NMDHB and CDHB)

Continue progression of implementation for the remaining DHBs


eMEDICINES PROGRAMME

ePharmacy Management (ePM)

Implement ePharmacy into South Island DHBs using a single Regional instance (incorporating NZULM & NZ Formulary when sources are available) to enable the management of medications from a shared South Island perspective

30 CDHB upgrade and WCDHB implementation complete

Q1


31 Business case for regional instance of ePharmacy approved6

Q2 Lead: Regional


32 Implementation of ePharmacy completed across remaining DHBs

Q4

REGIONAL PROVIDER INDEX (contingent on the approval of funding request)

To implement a SI Regional Provider index

33 Define and agree SI requirements for a single instance of RPI

Q1 Phased implementation across remaining SI DHBs commenced

Project closure Lead: IS SLA Reported in: SIHSP

34 Implement a single instance of the Regional provider index across CDHB

Q4

6 Contingent on having a completed review and agreed South Island Model for hospital pharmacy




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

35 Agree phased deployment across the remaining DHBs

Q4

eORDERING OF LABORATORY TESTS

To implement a fully electronic laboratory ordering process

36 Commence project scoping and agreement of regional direction.

Q4 Implementation commences

Continue progression of implementation


eORDERING OF RADIOLOGY TESTS

To implement a fully electronic radiology ordering process

37 Scope and commence implementation planning for SCDHB, WCDHB & NMDHB

Q4 Continue progression of implementation

Continue progression of implementation


SOUTH ISLAND MOBILITY STRATEGY FRAMEWORK

To define the South Island mobility framework

38 Define and agree components of a South Island mobility framework

Q4

Provide the SI DHBs with an agreed mobility framework that identifies minimum SI standards for when implementing a mobility strategy


HEALTH DATA

DATA ARCHITECTURE FRAMEWORK (Contingent on approval of funding request)

To define a regional data architecture framework7

39 Agree and define a South Island data architecture framework

Q4 Lead: IS SLA Reported in: SIHSP 40 Agree and define regional network security

policies and processes Q4

HEALTH CONNECT SOUTH

PROXIMITY AUDITING (Contingent on approval of funding request)

To implement privacy auditing to safeguard the sharing patient data across secondary and primary care in Health Connect South

41 Agree and approve the SI direction for proximity auditing within HCS

Q4

Implement a proximity auditing in SI DHBs across secondary and primary care in Health Connect South


SECURE MESSAGING FRAMEWORK

To define the SI clinical secure messaging strategy

42 Provide the SI DHBs with an agreed secure messaging framework that identifies minimum SI standards for attaching a digital message to a patients records

Q4


PREVENTIVE CARE

The Information Services, Service Level Alliance portfolio provides solutions that support the delivery of preventive care (i.e. the means to provide data for national collections such as screening initiatives). In the 2016/17 workplan there is not a specific programme solely focused on contributing towards preventive care.

7 The Regional Data Architecture Framework will adhere to all relevant National Standards including HiSO standards



Work supported by the Information Services Service Level Alliance

The Information Services, Service Level Alliance with the role of an enabler, will be support and/or monitoring the delivery of the following projects; South Island National Trauma Project National Patient Flow, eLearning, Safety First, Advance Care Planning, Growth Charts, Mental Health Module, MOSAIQ, MDM Meeting Management, South Island Clinical Cancer Information System. These projects with either be led by the Ministry or another regional Workstream or Alliance.

National projects enabled by the IS SLA but led nationally or by DHBs or by other South Island Workstreams

Project: National Trauma Minimum Dataset (page 57, item 4) Owner: South Island National Trauma Workstream

Project: National Infrastructure Programme Owner: Nationally led

Project: National Patient Flow Owner: Nationally led

Project: National Maternity Solution Owner: Nationally led and implemented by individual DHBs

Regional projects enabled by IS SLA but led by other SLAs and Workstreams

Project: Improved functionality and coverage of MDMs across the region (page 38, items 9&10) Project: South Island Clinical Cancer Information System (page 38, item 18) Owner: Southern Cancer Network

Project: Growth Charts (page 41, item 8b) Owner: Child Health SLA

Project: New electronic systems and tools will enable health professionals to securely share and gather relevant patient information that will result in safer, better and timely palliative care to patients (page 50, item 2a) Owner: Palliative Care Workstream

Project: South Island Electrocardiogram Clinical Data Repository (page 53, item 12) Owner: Cardiac Workstream

Project: Advance Care Plan (page 48, item 13) Owner: Health of Older Peoples SLA

Project: Safety First (Risk Management Project (RL6) (page 64, items 6c&f) Owner: Quality and Safety SLA.

Project: eLearning (page 75, item 5a) Owner: South Island Workforce Development Hub



South Island Workforce Development Hub

Lead CEO: David Meates, Canterbury DHB

Clinical Lead: Mary Gordon, Executive Director of Nursing and Midwifery (Canterbury DHB)

The South Island Workforce Development Hub (SIWDH) works with the South Island health whole of sector to improve

workforce development, education and training across the South Island to better meet the health needs of the South Island

population. This is achieved by:

Supporting innovative workforce development to ensure health professionals work to their full scope of practice in the new and emerging models of patient care with the support of an appropriately trained kaiawhina1 (unregulated) workforce

Strengthening the education and training networks across the South Island, focusing on enhancing and sharing innovative and multi-disciplinary approaches to healthcare delivery through effective education and training processes

Collaborating with the other Regional Workforce Development Hubs and Health Workforce New Zealand to share workforce development ideas and initiatives and by participating in national and regional fora.

The work plan for 2016-17 builds on the work of the SIWDH workgroups, which involve over 120 clinicians from across

health in the South Island. Further work to identify measures is ongoing and where appropriate these will be noted in the

quarterly reports.

The areas of focus for 2016-17 are:

Build and align the capability of the workforce to deliver new models of care

Improve the sustainability of priority (vulnerable) workforces

Grow the capacity and capability of Māori in the health workforce

Grow the capacity and capability of Pacific People in the health workforce

Optimise enablers to support workforce development

Optimise the capacity and capability of the health workforce

Strengthen health leadership through regional collaboration


ITEM NO


APPROVED SCHEDULE



RESPONSBILITIES

KEY ENABLERS

WORKFORCE & THE SOUTH ISLAND WORKFORCE DEVELOPMENT HUB BUILD AND ALIGN THE CAPACITY OF THE WORKFORCE TO DELIVER NEW MODELS OF CARE

1a Interprofessional

The opportunities for interprofessional learning in a clinical environment are increased

Q4 Implementation is continued. Progress is re-evaluated and action plan revised.

Lead: SIWDH Steering Group

Reported in: SIHSP

1b Interprofessional

A coordinated clinical simulation network for the South Island is established

Q4 An evaluation system is in place. Implementation is reviewed using evaluation information.

Contributors: SIWDH Steering Group

Reported in: SIHSP

1c Nurse Practitioner (NP):

NP roles have increased across the South Island in identified areas of need

Q4 Ongoing. Ongoing. Lead: South Island EDONs

Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSBILITIES

1d Clinical Nurse Specialists

Develop and support expert clinical nurse specialists groups to review and develop Lippincott clinical procedures

Q4 ongoing ongoing Lead: South Island EDONs

Reported in: SIHSP

1d

1e

Kaiawhina workforce

Allied Health Assistants (AHAs):

AHAs working across the South Island health system have access to appropriate NZQA level 3 training

Q4 Implementation of the New Level 3 NZQA qualification for Dental Assistants.

Ongoing

Lead: South Island Directors of Allied Health

Reported in: SIHSP

The Careerforce NZQA Level 4 Health and Wellbeing qualification is included in the AHA development framework

Q4 The initial cohort of trainees have completed their training using the Careerforce NZQA Level 4 Health and Wellbeing

An evaluation of the initial cohort has been completed.

The Level 4 AHA training and development framework is 100% implemented across the SI DHB’s.

Outcomes are embedded into the South Island development framework.


Reported in: SIHSP

1f Kaiawhina workforce

Allied Health Assistants (AHAs):

An effective delegation model is in place for services where Calderdale Framework has been implemented

Q4 Recommendations from evaluation have been reviewed and implemented.

Priority areas are identified for delegation activity in new CF projects. This may include working with other health professional groups.

An effective SI toolkit exists for delegation to AHAs within the CF model


Reported in: SIHSP

1g Workforce redesign

A workforce redesign model (Calderdale Framework) is used in Allied Health settings to allow Allied Health Professionals (AHPs) to work to the top of their scope

Q4 Training of the 2nd cohort is completed.

Standard outcome measures are included in all new CF projects.

Recommendations from evaluation have been reviewed and implemented.

A sustainable framework for the CF implementation is developed.


Reported in: SIHSP

Ensure sustainability of workforce redesign model across South Island

Q4 Ongoing Ongoing Lead: South Island Directors of Allied Health

Reported in: SIHSP

IMPROVE THE SUSTAINABILITY OF PRIORITY (VULNERABLE) WORKFORCES

2a Nursing

Strategy and planning to support older nurses to remain in the workforce and to maximise their contribution

Q4 Ongoing. Ongoing. Lead: SIWDH Nursing Sustainability Working Group and SI EDONs

Reported in: SIHSP

2b Sonography

Support for the training of Sonographers to meet the identified South Island need

Q4 Ongoing

Ongoing

Lead: South Island DAHs

Contributors: The South Island Sonography training group

Reported in: SIHSP

GROW THE CAPACITY AND CAPABILITY OF MAORI IN THE HEALTH WORKFORCE

3a Maori

Work alongside South Island GMs Maori to increase the number of Māori working in health

Q4 Ongoing. Ongoing. Lead: SIWDH Steering Group and SI GMs Maori

Reported in: SIHSP

3b Monitor DHB ethnicity workforce data (Maori and Pacific) to understand the current situation and trends

Q4 Ongoing. Ongoing. Lead: SIWDH

Reported in: SIHSP and SIWDH Workforce Report




ITEM NO


APPROVED SCHEDULE



RESPONSBILITIES

GROW THE CAPACITY AND CAPABILITY OF PACIFIC PEOPLE IN THE HEALTH WORKFORCE

4a Pacific

Continue work to identify how best to support increasing the number of Pacific working in health

Q4 Ongoing. Ongoing. Lead: SIWDH Steering Group

Reported in: SIHSP

OPTIMISE ENABLERS TO SUPPORT WORKFORCE DEVELOPMENT

5a eLearning platform

A common eLearning platform accessible to all South Island health workforce staff

Q4 Ongoing Ongoing Lead: SIWDH Steering Group and ISSLA

Contributors: eLearning working group.

Reported in: SIHSP

5b eLearning packages

An increased number of eLearning packages are available to the South Island health workforce

Q4 Regional learning packages continue to be developed.

Content developed is shared nationally.

Ongoing Lead: SIWDH Steering Group.

Reported in:SIHSP

5c Lippincott Procedures

The South Island and Midlands working in partnership designing a national framework for the management of Lippincott New Zealand instance

Q4 Ongoing review and development

Ongoing Lead: SI Executive Directors of Nursing in partnership with the Midland Region Executive Directors of Nursing

Contributors: Lippincott Project Board and Lippincott Implementation Group.

Reported in: SIHSP

5d Regional Health Library Service

Exploring the concept of a South Island regional health library service

Q4 To be determined To be determined Lead: SIWDH Steering Group Reported in:SIHSP

OPTIMISE THE CAPACITY AND CAPABILITY OF THE HEALTH WORKFORCE

6a Medicine

Community based attachments to meet requirements of new Medical Council curriculum

Q4 Increasing numbers to achieve 100% compliance in 2020.

Increasing numbers to achieve 100% compliance in 2020.

Lead: South Island Chief Medical Officers

Contributors: RMO Units

Reported in: SIHSP

6b Medicine

Support the DHBs to integrate the increased number of PGY1s (NZ citizens and permanent residents) into the workforce

Q4 The South Island has employed their share of the national total (114 in November 2017).

The South Island has employed their share of the national total (120 in November 2018).


Contributors: South Island RMO Units

Reported in: SIHSP

6c Rural Health

The opportunity of a regional rural health medicine clinical placement programme is explored

Q4 The identified pathway for clinical rotations is implemented.

The identified pathway for clinical rotations is evaluated.


Contributors: Rural Hospital Medicine working group.

Reported in: SIHSP




ITEM NO


APPROVED SCHEDULE



RESPONSBILITIES

STRENGTHEN HEALTH LEADERSHIP THROUGH REGIONAL COLLABORATION

7a Midwifery

A pathway has been developed for future clinical Midwifery Leaders

Q4 Ongoing. Ongoing. Lead: South Island Midwifery Leaders

Reported in: SIHSP

7b Allied Health Scientific & Technical leadership:

A regional clinical/professional leadership role is implemented for an Allied Health profession

Q4 Implementation of regional roles in other professions.

Ongoing Lead: South Island Directors of Allied Health

Reported in: SIHSP

An agreed framework for determining/establishing and implementing regional AHS&T clinical/professional leadership roles exists

Ongoing Ongoing Lead: South Island Directors of Allied Health

Reported in: SIHSP

Work supported by the South Island Workforce Development Hub

Regional projects enabled by SIWDH but led by other SLAs and Workstreams

A regional approach to cardiology nurse training developed (page 52, item 10)

Cardiac nurse educators supported to continue meeting quarterly

Agree and implement a draft plan Owner: Cardiac Services Workstream

Opportunities for training in echocardiography identified (page 53, item 11)

Implement recommendations formed in 2015/16 in conjunction with National Network Owner: Cardiac Services Workstream

Urology nursing (page 54, item 2)

Practice and service delivery supports clinical consistency, equity of access and improved patient outcomes via Lippincott Procedures Manual implementation

Owner: Elective Services

Workforce Development recommendation& integrated plan for primary & NGO sector (page 44,

Developing a workforce that supports the South Island withdrawal management plan pending the implications of the new legislation

Develop the capacity and capability of the practice nurse workforce

Develop a regional approach to increasing NESP capability in the NGO/Community setting Owner: Mental Health & Addictions SLA

Advance Care Planning (page 47, item 2)

ACP L 2 Training is available in a planned manner for staff in each DHB district in South Island (subject to resources) Owner: Health of Older People SLA

Dementia Services (page 48, item 8)

Continue to develop Walking in Another’s Shoes programme material for other staff groups (subject to funding)

Commence the development of material for use with a 2 day workshop for Aged Residential Care Managers

Owner: Health of Older People SLA



Workforce (page 60, item 6)

Training plans developed by each DHB to ensure relevant clinical staff are appropriately trained in trauma care Owner: Major Trauma Services

Ongoing education and training for interdisciplinary stroke team (page 64, item 7)

South Island Stroke teams have a minimum of 8 hours stroke specific education per year (minimum standard) Stroke teams have access to a range of educational opportunities (regional and local) to support continued development of knowledge and skill in delivering best practice stroke services

Owner: Stroke Services

Projects that continue to be supported or monitored by SIWDH

The nurse endoscopist who is training in Southern DHB as part of the bowel screening initiative lead by the Elective Services

workstream.

The development of palliative care nurse specialists and education roles in Hospices. This includes the establishment of a South

Island & Midland regional Lippincott palliative care expert group which includes Hospice and aged residential care nurses in

collaboration with the South Island Palliative Care workstream.

Medical physicists’ recruitment & retention in the South Island.



Support Services

Regionally consistent support functions enable the best clinical care at the best value for money.


Clinical Lead: Dr Geoff Shaw, Intensive Care Specialist (Canterbury DHB)

Chair: Jock Muir, Director, Strategic Projects (Canterbury DHB)

The Support Services SLA (SS SLA) has been formed to:

Secure better savings by aggregating procurement requirements, improving purchasing power and reducing procurement costs.

Align with national or other regional activity to deliver the best outcomes for cost and services.

Procure high value consumable product group, Assets (CAPEX) and non-clinical Services.

Eight key focus areas set the direction of this work plan:

Procurement and savings

Building networks

Project and savings collaboration with other Workstreams of the SLA

SS SLA maintains strong functioning, clinically-led workstreams

Manage change in conjunction with national agencies for local and regional benefits

Incorporate sustainability practices

Cultural and consumer input

St John Regional agreement for Patient Transfer service


ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

KEY ENABLERS

Support Services PROCUREMENT AND SAVINGS

Achieve and report savings in line with nationally agreed methodology

Aggregate procurement requirements and improve purchasing power

1 a Regional procurement policy (for non-health Alliance – out of scope) adhered to.

Maintenance of efficient procurement activity resulting in regional savings and risk mitigation for South Island DHBs. Regional procurement policy implemented to end user satisfaction

Maintenance of efficient procurement activity resulting in regional savings and risk mitigation for South Island DHBs

Procurement and Supply Chain Workstream;

P and SC managers in each district implemernt

1 b Regional procurement plan (for non-health Alliance – out of scope) activities adhered to.



Procurement and Supply Chain Workstream;

P and SC managers in each district implement

1 c Procurement projects active and achieved through collaboration with other agencies for example DHBs, health Alliance, Pharmac, MOBIE

Maintenance of efficient procurement activity resulting in regional savings

Maintenance of efficient procurement activity resulting in regional savings




ITEM NO


APPROVED SCHEDULE



RESPONSIBILITIES

1 d Savings of $3 million (using nationally agreed methodology) achieved during the 2016 - 17 year through the South Island Procurement and Supply Chain workstream

Savings of $3 million (using nationally agreed methodology) reported during the 2017-18 year through the South Island Procurement and Supply Chain workstream

Savings of $3 million (using nationally agreed methodology) reported during the 2018-19 year through the South Island Procurement and Supply Chain workstream

SS SLA

MAINTAIN RELATIONSHIPS WITH STAFF IN KEY RELATED SERVICES, FROM RELEVANT LOCAL, REGIONAL AND NATIONAL HEALTH SERVICES ORGANISATIONS

Representation on SS SLA & workstreams includes: clinical representation and key national bodies

2 a Clinical endorsement of initiatives. Maintenance of strong clinically endorsed activity

Maintenance of strong clinically endorsed activity

SS SLA

2 b Input by national agencies to workplans.



SS SLA

PROJECT AND SAVINGS IN COLLABORATION WITH OTHER WORKSTREAMS OF THE SLA

Align with the target of collective procurement driven by national agencies

3 Increased rationalisation and standardisation of products and services.

Maintain increased rationalisation and standardisation of products and services by working in conjunction with other key agencies

Maintain increased rationalisation and standardisation of products and services by working in conjunction with other key agencies

SS SLA

SS SLA MAINTAIN STRONG FUNCTIONING CLINICALLY LED WORKSTREAMS

Workstream’s workplan contain at least three quantifiable, measureable Key Performance Indicators (KPIs), at least one of which is financial

4 KPIs reported and monitored. Strong functional workstreams delivering results

Strong functional workstreams delivering results

SS SLA

MANAGE CHANGE IN CONJUNCTION WITH NATIONAL AGENCIES FOR LOCAL AND REGIONAL BENEFITS

Opportunities for joint ventures with providers of services

5 Opportunities agreed and implemented where appropriate.

Additional local and regional benefits gained from collaborative projects

Additional local and regional benefits gained from collaborative projects

SS SLA

ST JOHN REGIONAL AGREEMENT FOR INTER HOSPITAL TRANSFERS (IHT)

Facilitate the annual review of the regional IHT agreement negotiated between the South Island DHBs and St John.

6 Annual review of the regional Inter-Hospital Transfers agreement completed.

Review agreement

Q2

Review agreement

Q2

SS SLA

INCORPORATE SUSTAINABILTY PRACTICES

Workstreams incorporate sustainability practices

7 Sustainability practices acknowledged in workstreams

Sustainable practices enhanced with increased knowledge

Sustainable practices enhanced with increased knowledge

SS SLA with support from Public Health Partnership

CULTURAL AND CONSUMER INPUT

Opportunities for cultural and consumer input investigated

8 Cultural and consumer input acknowledged in workstreams

Increased range of knowledge and skills enhances Support Services work

Increased range of knowledge and skills enhances Support Services work

SS SLA

SOUTH ISLAND HEALTH SERVICES PLAN 2016-19 Appendix Five


Appendix 5: Memberships of Alliance groups

Strategic Planning and Integration team

Name Title DHB

Dr Carol Atmore (Chair) General Practitioner Primary Care, Otago

Carolyn Gullery General Manager, Planning and Funding CDHB

Hilary Exton Service Manager and Director of Allied Health NMDHB

Dr Daniel Williams Clinical Director, Community and Public Health CDHB

Lynda McCutcheon Director of Allied Health, Scientific and Technical SDHB

Pania Coote Executive Director of Māori Health SDHB

Karyn Bousfield Director of Nursing and Midwifery WCDHB

Steve Earnshaw Orthopaedic Surgeon SCDHB

Jan Barber General Manager South Island Alliance Programme Office SIAPO

Service Level Alliances and Workstreams

SLA Name Title DHB

Southern Cancer Network

Dr Steve Gibbons (Chair) Haematologist, Clinical Services CDHB

Dr Shaun Costello Clinical Director, Southern Cancer Network/Clinical Director Medicine & Radiation Oncologist

SDHB

Elizabeth Cunningham Māori representative Te Waipounamu Māori Leadership Group

Theona Ireton Kaitiaki CDHB

Marj Allan Consumer & South Island Alliance Palliative Care Canteen

Danielle Smith Cancer Support Coordinator West Coast PHO

Dr Tristan Pettit Paediatric Oncology CDHB

Pania Coote Acting Executive Director of Māori Health SDHB

Christine Nolan General Manager Secondary Services SCDHB

Michelle Driffill Regional Manger Northern South Island for CanTeen Canterbury

Andrew Lesperance General Manager Planning & Funding NMDHB

Mike Kernaghan Chief Executive Cancer Society, Southern

Di Riley Southern Cancer Network Manager SCN

Child Health Services Dr David Barker (Chair) Clinical Director, Women’s and Children’s Health SDHB

Dr Nick Baker Community Paediatrician NMDHB

Dr Clare Doocey Paediatrician CDHB

Anne Morgan Service Manager, Child Health CDHB

Donna Addidle Service Manager, Child Health SCDHB

Dr Nicola Austin Paediatrician CDHB

Dr Mick Goodwin Paediatrician SCDHB

Prof Barry Taylor Professor of Paediatrics University of Otago

Dr Viv Patton General Practitioner Paediatric Liaison CDHB

Wayne Turp Project Specialist, Planning and Funding CDHB

Jaana Kahu Māori Child and Youth Health Te Tai o Marokura

Traci Stanbury Consumer Canterbury

Rosalie Waghorn Nurse Manager Clinical Services - Strategic WCDHB

Jane Haughey Facilitator SIAPO



Health of Older People Services

Dr Val Fletcher General Practitioner CDHB

Michael Parker CEO, Presbyterian Support Service South Canterbury South Canterbury

Carole Kerr Walking in Another’s Shoes Dementia Educator NMDHB

Margaret Hill General Manager, Strategy, Planning and Accountability SCDHB

Dr Stanley Smith Geriatrician SCDHB

Kate Gibb Nursing Director, Older People – Population Health, CDHB

Karen Kennedy Community Pharmacist, Primary and Community Services SCDHB

Jane Large Facilitator SIAPO

Ann Armstrong Consumer member Nelson

Andrew Metcalf Director Allied Health SDHB

Palliative Care Dr Kate Grundy (Chair) Consultant Physician in Palliative Medicine CDHB

Dr Stanley Smith Geriatrician SCDHB

Dr Amanda Lyver Clinical Director of Paediatric Oncology CDHB

Marj Allan Consumer West Coast

Kate Gibb Nursing Director Older People and Population Health CDHB

Carla Arkless Palliative Care Nurse Practitioner Presbyterian Support Southland

Rachel Teulon Clinical Nurse Specialist, Paediatric Palliative Care Nurse Maude

Dr Brigid Forest General Practitioner Hospice Marlborough

Jane Rollings Service Manager Nurse Maude

Sharon Stewart Nurse Leader Otago Community Hospice

Sharon Adler Portfolio Manager Planning and Funding SDHB.

Rachel Nicolson-Hitt Clinical Development Manager St John South Island

Theona Ireton Māori representative CDHB

Lydia Bras Social Worker CDHB

Jane Haughey Facilitator SIAPO

Mental Health & Addiction Services

Dr David Bathgate (Chair) Consultant Psychiatrist SDHB

Dr Alfred Dell’Ario Consultant Psychiatrist CDHB/WCDHB

Heather Casey Director of Nursing SDHB

Rose Henderson Allied Health CDHB

Paul Wynands Primary Care Rural Canterbury PHO

Robyn Byers General Manager NMDHB

Sandra Boardman Executive Director Planning and Funding SDHB

Karaitiana Tickell CEO, Purapura Whetu Trust Canterbury

Thomas Cardy Operations Manager pact

Dianne Black Consumer Advisor South Canterbury

Martin Kane Facilitator SIAPO

Support Services Jock Muir (Chair) Director, Strategic Projects CDHB

Dr Geoff Shaw (Clinical Lead) Intensive Care Specialist CDHB

Jane Wilson Acting Director Nursing Operations SDHB

Eric Sinclair General Manager Finance & Performance NMDHB

Mark Newsome General Manager Grey/Westland Health Services WCDHB

Dr Peter Bramley Service Director, Medical Surgical Services WCDHB

Elaine Chisnall General Manager, Women’s, Children’s, Public Health and Support Services

SDHB

Alan Lloyd Facilitator SIAPO



Information Services Dr Andrew Bowers (Chair) Medical Director, Information Technology and Physician SDHB

Dr Bev Nicolls Community Based Services Directorate / General

Practitioner

NMDHB & Stoke Medical Centre

Nigel Trainor Chief Executive SCDHB

Chris Dever Chief Information Officer CDHB

Jane Brosnahan Nursing, Midwifery and Allied Health SCDHB

John Beveridge Nurse Consultant CDHB

Dr Nigel Millar Chief Medical Officer SDHB

Dr Russell Rarity Clinical Director, Anaesthetics SCDHB

Stella Ward Executive Director, Allied Health CDHB/WCDHB

Patrick Ng General Manager IT & Infrastructure NMDHB

Carolyn Gullery General Manager, Planning and Funding CDHB

Dr Peter Gent General Practitioner Mornington Health Centre

Sheree East Nursing Director Nurse Maude

Paul Goddard Programme Director, Information Services SIAPO

Sonya Morice Facilitator SIAPO

Quality and Safety Mary Gordon (Chair) Executive Director of Nursing CDHB

Ken Stewart Community Physiotherapist Selwyn Village Physiotherapy

Karen Vaughan General Manager Organisational Development NMDHB

Tina Gilbertson General Manager Organisational Development SDHB

Chris Eccleston General Manager Clinical Governance SCDHB

Dr Elizabeth Wood General Practitioner, Executive Clinical Director NMDHB Mapua Health Centre, NMDHB

Dr Lynley Cook Population Health Specialist Pegasus Health

Carolyn Gullery General Manager Planning and Funding CDHB/WCDHB

Mark Newsome General Manager Grey and Westland Health Services WCDHB

Anna Carey Facilitator SIAPO

Cardiac Services Dr David Smyth (Chair) Cardiologist & Clinical Director of Cardiology CDHB

Lisa Smith Cardiac Clinical Nurse Specialist WCDHB

Gary Barbara Service Manager CDHB

Dr Bernard Kuepper Consultant Internal Medicine/Cardiology SCDHB

Dr Rachael Byars Physician and Clinical Leader SDHB

Christine Nolan General Manager Secondary Services SCDHB

Dr Garry Nixon Medical Officer Dunstan Hospital

Dr Nick Fisher Consultant Cardiologist NMDHB

Dr Belinda Green Cardiologist SDHB

Curt Ward Clinical Practice Manager, South Island, St John Independent




Elective Services Andrew Lesperance General Manager Strategy, Planning and Alliance Support NMDHB

Carolyn Gullery General Manager, Planning and Funding CDHB/WCDHB

Margaret Hill General Manager Strategy Planning and Accountability SCDHB

Sandra Boardman Executive Director of Planning and Funding SDHB

Dr Peter Bramley General Manager Clinical Services NMDHB

Pauline Clark General Manager, Christchurch Hospital CDHB

Christine Nolan General Manager, Secondary Services SCDHB

Lexie O’Shea Executive Director of Patient Service SDHB

Mark Newsome General Manager Grey Westland Health Services WCDHB

Janice Donaldson Programme Manager, South Island Electives SIAPO

Major Trauma Dr Mike Hunter (Chair) Clinical Leader ICU SDHB

Maureen Beentjes Southern Region Emergency Care Coordinator Team Coordinator and Snr Registered Nurse ICU

SDHB

Dr Vicky Mann Radiologist (Trauma/ED) CDHB

Dr Dominic Fleischer Specialist Emergency Physician CDHB

Dr Christopher Wakeman Surgical Consultant CDHB

Lesley Owens Service Manager CDHB

Dr Peter Kyriakoudis Medical Officer WCDHB

Dr Peter Doran SMO Anaesthetist SCDHB

Rachel Nicholson-Hitt Clinical Development Manager, South Island St John

Ralph la Salle Team Leader, Secondary Care, Planning and Funding CDHB

Dr Alf Deacon General Surgeon NMDHB

Dr Martin Watts Emergency Medicine Specialist, Acting Clinical Leader SDHB

Phyllis Meier Category Delivery Manager, Rehabilitation Services ACC


Stroke Services Dr John Fink (Chair) Clinical Director, Neurology CDHB

Dr Wendy Busby Consultant Physician & Geriatrician SDHB

Clare Jamieson Occupational Therapist CDHB

Julian Waller Stroke Clinical Nurse Specialist SCDHB

Dr Suzanne Busch Geriatrician, General Physician NMDHB

Dr Carl Hanger Stroke Rehabilitation Consultant & Geriatrician CDHB

Nanette Ainge Planning & Funding CDHB

Allison Gallant Nurse Coordinator Acute Stroke CDHB

Margot van Mulligen Physiotherapist WCDHB

Jane Large Facilitator SIAPO

South Island Public Health Partnership

Dr Ed Kiddle (Chair) Medical Officer of Health NMDHB

Dr Keith Reid Clinical Leader, Medical Officer of Health SDHB

Evon Currie General Manager, Community & Public Health CDHB, WCDHB, SCDHB

Dr Daniel Williams Clinical Director, Community & Public Health, Medical Officer of Health SCDHB

CDHB, WCDHB, SCDHB

Peter Burton Public Health Service Manager NMDHB

Grant Pollard Group Manager, Public Health Group MoH

Dr Ramon Pink Medical Officer of Health, and Māori Public Health Portfolio

CDHB

Lynette Finnie Service Manager, Public Health Services SDHB

Margaret Bunker South Island Alliance Programme Co-ordinator SIAPO

Ruth Teasdale Facilitator SIAPO



South Island Workforce Development Hub

Name Title Organisation

Mary Gordon (Chair) Executive Director of Nursing CDHB

To be advised Director of Midwifery

Lynda McCutcheon Director of Allied Health, Scientific and Technical SDHB

Nigel Millar Chief Medical Officer SDHB

Pania Coote Acting Executive Director of Māori Health SDHB

Pam Kiesanowski Director of Nursing and Midwifery NMDHB

Margaret Bunker South Island Alliance Programme Coordinator SIAPO

Sarah Creegan General Practitioner, Waimate Medical Centre SCDHB/Primary Care

Kate Rawlings Regional Programme Director Training SIAPO

Kathryn Goodyear Facilitator SIAPO

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